Provider Demographics
NPI:1811542582
Name:MCKINNEY, BRANDON MICHAEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MICHAEL
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8375 SHORTHORN DR
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-3225
Mailing Address - Country:US
Mailing Address - Phone:330-467-9635
Mailing Address - Fax:
Practice Address - Street 1:3402 CLARK AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1136
Practice Address - Country:US
Practice Address - Phone:216-961-9414
Practice Address - Fax:216-651-8205
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03439091OtherPHARMACY LICENSE