Provider Demographics
NPI:1083195721
Name:DAVIS, BRANDON EDWIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:EDWIN
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10815 POLO DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-4192
Mailing Address - Country:US
Mailing Address - Phone:661-477-0937
Mailing Address - Fax:
Practice Address - Street 1:2303 NILES PT
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-4025
Practice Address - Country:US
Practice Address - Phone:661-325-2487
Practice Address - Fax:661-325-0654
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85653183500000X, 3336C0003X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program