Provider Demographics
NPI:1699018713
Name:NODDINGS, BRANDON MACFRE
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:MACFRE
Last Name:NODDINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5342 ISLAND GYPSY DR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-5955
Mailing Address - Country:US
Mailing Address - Phone:561-452-4310
Mailing Address - Fax:
Practice Address - Street 1:1615 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3418
Practice Address - Country:US
Practice Address - Phone:352-380-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49806183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist