Provider Demographics
NPI:1013254176
Name:THACH, BRANDON V
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:V
Last Name:THACH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRANDON
Other - Middle Name:V
Other - Last Name:THACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:160 MARINER BLVD
Mailing Address - Street 2:160 MARINER BLVD
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5689
Mailing Address - Country:US
Mailing Address - Phone:352-688-2305
Mailing Address - Fax:352-666-2122
Practice Address - Street 1:160 MARINER BLVD
Practice Address - Street 2:160 MARINER BLVD
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5689
Practice Address - Country:US
Practice Address - Phone:352-688-2305
Practice Address - Fax:352-666-2122
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39614183500000X
MAPH23820183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist