Provider Demographics
NPI:1942891692
Name:LOCKE, BREANNA A (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:A
Last Name:LOCKE
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 1:1232 BELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-7328
Mailing Address - Country:US
Mailing Address - Phone:828-557-0130
Mailing Address - Fax:
Practice Address - Street 1:178 BRACKETTS WAY STE 7
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-2984
Practice Address - Country:US
Practice Address - Phone:706-400-5043
Practice Address - Fax:706-400-5046
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist