Provider Demographics
NPI:1619124690
Name:MARCANTEL, BRIAN NELSON (PD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:NELSON
Last Name:MARCANTEL
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7697 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2202
Mailing Address - Country:US
Mailing Address - Phone:901-248-0251
Mailing Address - Fax:901-248-0251
Practice Address - Street 1:7697 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2202
Practice Address - Country:US
Practice Address - Phone:901-248-0251
Practice Address - Fax:901-248-0251
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD10285183500000X
TN26653183500000X
TX42179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist