Provider Demographics
NPI:1083901953
Name:BILLMAN, BRANDON JOSEPH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:JOSEPH
Last Name:BILLMAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 N PROSPECT AVE
Mailing Address - Street 2:T0943
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1231
Mailing Address - Country:US
Mailing Address - Phone:217-355-3345
Mailing Address - Fax:
Practice Address - Street 1:2102 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1231
Practice Address - Country:US
Practice Address - Phone:217-355-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.294928183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist