Provider Demographics
NPI:1417553322
Name:BRANSON, MAHALA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MAHALA
Middle Name:
Last Name:BRANSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4807 E 181ST ST
Mailing Address - Street 2:
Mailing Address - City:OVERBROOK
Mailing Address - State:KS
Mailing Address - Zip Code:66524-9505
Mailing Address - Country:US
Mailing Address - Phone:785-438-0499
Mailing Address - Fax:
Practice Address - Street 1:1301 SW 37TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-2308
Practice Address - Country:US
Practice Address - Phone:785-267-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-16815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist