Provider Demographics
NPI:1669682472
Name:BRAND, STEFAN JOSEF (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEFAN
Middle Name:JOSEF
Last Name:BRAND
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 FARBER LAKES DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5779
Mailing Address - Country:US
Mailing Address - Phone:716-635-3971
Mailing Address - Fax:716-631-9636
Practice Address - Street 1:511 FARBER LAKES DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5779
Practice Address - Country:US
Practice Address - Phone:716-635-3971
Practice Address - Fax:716-631-9636
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042802-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01628160Medicaid
NY042802-1OtherPHARMACY LICENSE