Provider Demographics
NPI:1093311243
Name:HUBBARD, BRANDY NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:NICOLE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:BRANDY
Other - Middle Name:NICOLE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:620 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2911
Mailing Address - Country:US
Mailing Address - Phone:870-414-4017
Mailing Address - Fax:870-414-4909
Practice Address - Street 1:620 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2911
Practice Address - Country:US
Practice Address - Phone:870-414-4017
Practice Address - Fax:870-414-4909
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD136681835P2201X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care