Provider Demographics
NPI:1558691899
Name:BRANCATO, MICHAEL A JR
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:BRANCATO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 ALICE PAUL LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-9836
Mailing Address - Country:US
Mailing Address - Phone:602-791-1752
Mailing Address - Fax:
Practice Address - Street 1:3620 PLAINFIELD RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46231
Practice Address - Country:US
Practice Address - Phone:602-791-1752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-09
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15249183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist