Provider Demographics
NPI:1619180130
Name:ANDERSON, BRANDON REGAN (B PHARM)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:REGAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:B PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 COBBLE CT
Mailing Address - Street 2:
Mailing Address - City:NEW CUMBERLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17070-2241
Mailing Address - Country:US
Mailing Address - Phone:717-770-1188
Mailing Address - Fax:717-770-1188
Practice Address - Street 1:105 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17070-2485
Practice Address - Country:US
Practice Address - Phone:717-774-0261
Practice Address - Fax:717-774-2810
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439187183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist