Provider Demographics
NPI:1598979718
Name:BRANSON, GAYLE MUCELLI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:MUCELLI
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 1:2535 E 37TH PLZ
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-6628
Mailing Address - Country:US
Mailing Address - Phone:850-896-3519
Mailing Address - Fax:
Practice Address - Street 1:2535 E 37TH PLZ
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-6628
Practice Address - Country:US
Practice Address - Phone:850-896-3519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32852183500000X
FLMH17643101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1059838OtherNCPDP
FLPS32852OtherFLORIDA LICENSE