Provider Demographics
NPI:1629516695
Name:LADAGE, BRANDON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:LADAGE
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 1:5908 WASHINGTON PIKE
Mailing Address - Street 2:STE 102
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-7100
Mailing Address - Country:US
Mailing Address - Phone:865-525-4967
Mailing Address - Fax:
Practice Address - Street 1:5908 WASHINGTON PIKE
Practice Address - Street 2:STE 102
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-7100
Practice Address - Country:US
Practice Address - Phone:865-525-4967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN755133OtherNABP