Provider Demographics
NPI:1679223887
Name:FUENTES, BRANDI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:
Last Name:FUENTES
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 1:1005 KENTS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HONAKER
Mailing Address - State:VA
Mailing Address - Zip Code:24260-8046
Mailing Address - Country:US
Mailing Address - Phone:276-202-4717
Mailing Address - Fax:
Practice Address - Street 1:31 E VALLEY DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-2822
Practice Address - Country:US
Practice Address - Phone:276-202-4717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202219386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist