Provider Demographics
NPI:1124228978
Name:BRANSCUM, HEATH NOLEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEATH
Middle Name:NOLEN
Last Name:BRANSCUM
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 1:1800 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAVACA
Mailing Address - State:AR
Mailing Address - Zip Code:72941-3802
Mailing Address - Country:US
Mailing Address - Phone:479-674-2222
Mailing Address - Fax:
Practice Address - Street 1:213 E HOWARD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:AR
Practice Address - Zip Code:72944-3411
Practice Address - Country:US
Practice Address - Phone:479-928-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12336183500000X
AR08703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist