Provider Demographics
NPI:1083840425
Name:UNDERWOOD, BRANTLEY MICHAEL (PHARMD, MBA, CSP)
Entity Type:Individual
Prefix:DR
First Name:BRANTLEY
Middle Name:MICHAEL
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:PHARMD, MBA, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4294
Mailing Address - Country:US
Mailing Address - Phone:931-783-2552
Mailing Address - Fax:931-783-2553
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4294
Practice Address - Country:US
Practice Address - Phone:931-783-2552
Practice Address - Fax:931-783-2553
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK117751183500000X
OKR-16138183500000X
ARPD13265183500000X
WAPH60661034183500000X
TN44702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist