Provider Demographics
NPI:1164058426
Name:CREVAR, BRANDI SYNCLAIR (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:SYNCLAIR
Last Name:CREVAR
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:SYNCLAIR
Other - Last Name:BURKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2394 HADLEY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-7104
Mailing Address - Country:US
Mailing Address - Phone:229-327-4135
Mailing Address - Fax:
Practice Address - Street 1:301 S BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-5546
Practice Address - Country:US
Practice Address - Phone:229-228-7658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist