Provider Demographics
NPI:1710224662
Name:FANNON, BRANDI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDI
Middle Name:
Last Name:FANNON
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 1:1950 LAKE PARK DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7648
Mailing Address - Country:US
Mailing Address - Phone:770-970-2735
Mailing Address - Fax:
Practice Address - Street 1:1950 LAKE PARK DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7648
Practice Address - Country:US
Practice Address - Phone:770-970-2735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-12
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34448183500000X
GARPH026503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist