Provider Demographics
NPI:1932703683
Name:BRANCH, TEKERRA (RPH)
Entity Type:Individual
Prefix:DR
First Name:TEKERRA
Middle Name:
Last Name:BRANCH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:TWIN CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30471-4107
Mailing Address - Country:US
Mailing Address - Phone:478-494-5157
Mailing Address - Fax:
Practice Address - Street 1:1025 HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4209
Practice Address - Country:US
Practice Address - Phone:478-275-9897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031779183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist