Provider Demographics
NPI:1225447485
Name:BRANNON STAND DRUGS, INC.
Entity Type:Organization
Organization Name:BRANNON STAND DRUGS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:850-326-1525
Mailing Address - Street 1:1971 S BRANNON STAND RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-7180
Mailing Address - Country:US
Mailing Address - Phone:334-446-5300
Mailing Address - Fax:334-446-3122
Practice Address - Street 1:1971 S BRANNON STAND RD
Practice Address - Street 2:SUITE 1
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-7180
Practice Address - Country:US
Practice Address - Phone:334-446-5300
Practice Address - Fax:334-446-3122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL165755Medicaid