Provider Demographics
NPI:1154644078
Name:OBERNESSER, BRANDEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDEN
Middle Name:
Last Name:OBERNESSER
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 1:141 ORISKANY BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-1549
Mailing Address - Country:US
Mailing Address - Phone:315-736-4943
Mailing Address - Fax:
Practice Address - Street 1:141 ORISKANY BLVD
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492-1549
Practice Address - Country:US
Practice Address - Phone:315-736-4943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist