Provider Demographics
NPI:1629796198
Name:CRYER, BRANDON HEATH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:HEATH
Last Name:CRYER
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:PO BOX 255
Mailing Address - Street 2:
Mailing Address - City:TIPTON
Mailing Address - State:OK
Mailing Address - Zip Code:73570-0255
Mailing Address - Country:US
Mailing Address - Phone:580-471-7824
Mailing Address - Fax:
Practice Address - Street 1:3612 SE LEE BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-8451
Practice Address - Country:US
Practice Address - Phone:580-355-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2023-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK19764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK19764OtherOKLAHOMA STATE BOARD OF PHARMACY