Provider Demographics
NPI:1134699762
Name:WEBER, BRANDON CRAIG (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:CRAIG
Last Name:WEBER
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 1:6965 SOMERSET FARMS CIR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2377
Mailing Address - Country:US
Mailing Address - Phone:734-837-0854
Mailing Address - Fax:
Practice Address - Street 1:1443 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3198
Practice Address - Country:US
Practice Address - Phone:615-444-8814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000042171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist