Provider Demographics
NPI:1407146244
Name:BRANCACCIO, MARC CHRISTOPHER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:CHRISTOPHER
Last Name:BRANCACCIO
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 1:7470 BROCKWAY RD
Mailing Address - Street 2:
Mailing Address - City:BROCKWAY
Mailing Address - State:MI
Mailing Address - Zip Code:48097-3458
Mailing Address - Country:US
Mailing Address - Phone:810-387-3211
Mailing Address - Fax:810-387-2279
Practice Address - Street 1:7470 BROCKWAY RD
Practice Address - Street 2:
Practice Address - City:BROCKWAY
Practice Address - State:MI
Practice Address - Zip Code:48097-3458
Practice Address - Country:US
Practice Address - Phone:810-387-3211
Practice Address - Fax:810-387-2279
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020404891835P0018X
NC20406183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty