Provider Demographics
NPI:1558978460
Name:SMITH, BRANDON WAYNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:WAYNE
Last Name:SMITH
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 1:1185 W MOUNTAIN VIEW RD APT 141
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2523
Mailing Address - Country:US
Mailing Address - Phone:606-515-3464
Mailing Address - Fax:
Practice Address - Street 1:1650 E ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4274
Practice Address - Country:US
Practice Address - Phone:423-638-4889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist