Provider Demographics
NPI:1164903837
Name:BRANHAM, TANDY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TANDY
Middle Name:
Last Name:BRANHAM
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 1:179 LAKEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-3009
Mailing Address - Country:US
Mailing Address - Phone:276-451-1554
Mailing Address - Fax:
Practice Address - Street 1:527 N STATE OF FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8210
Practice Address - Country:US
Practice Address - Phone:423-975-0597
Practice Address - Fax:423-975-6304
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27623183500000X
AL20253183500000X
KY019789183500000X
VA0202216454183500000X
TN41295183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist