Provider Demographics
NPI:1326731696
Name:BUCHANAN, BRANDON EUGENE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:EUGENE
Last Name:BUCHANAN
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 1:2445 FAIRFIELD AVE APT 113
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-1238
Mailing Address - Country:US
Mailing Address - Phone:989-475-2245
Mailing Address - Fax:
Practice Address - Street 1:6202 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-3073
Practice Address - Country:US
Practice Address - Phone:260-432-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN45023735A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist