Provider Demographics
NPI:1649558404
Name:GRIST, BRANDI MICHELLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:MICHELLE
Last Name:GRIST
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-1616
Mailing Address - Country:US
Mailing Address - Phone:704-827-2211
Mailing Address - Fax:704-827-7134
Practice Address - Street 1:125 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-1616
Practice Address - Country:US
Practice Address - Phone:704-827-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist