Provider Demographics
NPI:1245640275
Name:MCCUNE, BRANDON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:MCCUNE
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 1:212 E 8TH ST # 640
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:OK
Mailing Address - Zip Code:73932-3184
Mailing Address - Country:US
Mailing Address - Phone:580-625-3646
Mailing Address - Fax:
Practice Address - Street 1:212 E 8TH ST # 640
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:OK
Practice Address - Zip Code:73932-3184
Practice Address - Country:US
Practice Address - Phone:580-625-3646
Practice Address - Fax:580-625-3844
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-16171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist