Provider Demographics
NPI:1356946362
Name:DENNIS, BRANDON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:
Last Name:DENNIS
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 1:1742 DEES DR
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-1090
Mailing Address - Country:US
Mailing Address - Phone:912-650-1702
Mailing Address - Fax:
Practice Address - Street 1:1029 FOREST PKWY
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2350
Practice Address - Country:US
Practice Address - Phone:404-608-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032182183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist