Provider Demographics
NPI:1295336139
Name:WRENN, BRANDY M
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:M
Last Name:WRENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 HICKORY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-8753
Mailing Address - Country:US
Mailing Address - Phone:901-515-8904
Mailing Address - Fax:
Practice Address - Street 1:200 MARKET PL
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218-4429
Practice Address - Country:US
Practice Address - Phone:601-919-2958
Practice Address - Fax:601-939-4489
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE13634183500000X
MSE13936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist