Provider Demographics
NPI:1437779261
Name:BRANNAN, MELVIN DOUGLAS (PHD, RPH)
Entity Type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:DOUGLAS
Last Name:BRANNAN
Suffix:
Gender:M
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2097 WILLIAM DANCE WAY
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-7748
Mailing Address - Country:US
Mailing Address - Phone:804-869-9767
Mailing Address - Fax:
Practice Address - Street 1:1756 ANDERSON HWY
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:VA
Practice Address - Zip Code:23040-2524
Practice Address - Country:US
Practice Address - Phone:804-492-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004054183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0202004054OtherPHARMACIST LICENSE