Provider Demographics
NPI:1184366965
Name:FEIST, BRANDEN LEE (PHARMD)
Entity type:Individual
Prefix:
First Name:BRANDEN
Middle Name:LEE
Last Name:FEIST
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 1:2807 E 64TH CT
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3523
Mailing Address - Country:US
Mailing Address - Phone:563-343-6365
Mailing Address - Fax:
Practice Address - Street 1:2807 E 64TH CT
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3523
Practice Address - Country:US
Practice Address - Phone:563-343-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist