Provider Demographics
NPI:1629375522
Name:MARSHALL, BRANDON DERRICK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:DERRICK
Last Name:MARSHALL
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 1:412 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PITTSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37380-1236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:740 MAIN ST
Practice Address - Street 2:
Practice Address - City:TRACY CITY
Practice Address - State:TN
Practice Address - Zip Code:37387-4020
Practice Address - Country:US
Practice Address - Phone:931-592-9190
Practice Address - Fax:931-592-9203
Is Sole Proprietor?:No
Enumeration Date:2011-02-12
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist