Provider Demographics
NPI:1255829354
Name:HOLBROOK, BRANDON LEE (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:HOLBROOK
Suffix:
Gender:M
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 ROCKFORD DR
Mailing Address - Street 2:
Mailing Address - City:LUCASVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45648-7809
Mailing Address - Country:US
Mailing Address - Phone:740-259-0041
Mailing Address - Fax:740-259-0044
Practice Address - Street 1:37C LUCASVILLE MINFORD RD
Practice Address - Street 2:
Practice Address - City:LUCASVILLE
Practice Address - State:OH
Practice Address - Zip Code:45648-9023
Practice Address - Country:US
Practice Address - Phone:740-259-0041
Practice Address - Fax:740-259-0044
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03230654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist