Provider Demographics
NPI:1700168606
Name:MARRETTA, BRANDON MARK (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MARK
Last Name:MARRETTA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582-4312
Mailing Address - Country:US
Mailing Address - Phone:337-394-6214
Mailing Address - Fax:
Practice Address - Street 1:1730 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT MARTINVILLE
Practice Address - State:LA
Practice Address - Zip Code:70582-4312
Practice Address - Country:US
Practice Address - Phone:337-394-6214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.019177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist