Provider Demographics
NPI:1154440014
Name:BRANCH, ALBERT W (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:W
Last Name:BRANCH
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 1:104 KNOB HILL RD
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-4219
Mailing Address - Country:US
Mailing Address - Phone:229-259-0350
Mailing Address - Fax:229-259-0350
Practice Address - Street 1:1105 MADISON HWY
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-5958
Practice Address - Country:US
Practice Address - Phone:229-242-2205
Practice Address - Fax:229-259-9029
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA018305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist