Provider Demographics
NPI:1184241440
Name:HOLBROOK, BRANDON G (PHARMD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:G
Last Name:HOLBROOK
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 1:23955 HURON RIVER DR
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48173-9701
Mailing Address - Country:US
Mailing Address - Phone:734-775-5284
Mailing Address - Fax:
Practice Address - Street 1:32905 FORT RD
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:MI
Practice Address - Zip Code:48173-1112
Practice Address - Country:US
Practice Address - Phone:734-379-9633
Practice Address - Fax:734-379-0952
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2020-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302412558183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist