Provider Demographics
NPI:1407452741
Name:STAGGS, BRANDON TYLER (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:TYLER
Last Name:STAGGS
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 1:2891 KIRBY RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8209
Mailing Address - Country:US
Mailing Address - Phone:901-757-5017
Mailing Address - Fax:
Practice Address - Street 1:2891 KIRBY RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8209
Practice Address - Country:US
Practice Address - Phone:901-757-5017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38535183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist