Provider Demographics
NPI:1740488600
Name:GRIFFIN, MICHAEL BRANDON (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRANDON
Last Name:GRIFFIN
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:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31722-0296
Mailing Address - Country:US
Mailing Address - Phone:229-324-2035
Mailing Address - Fax:
Practice Address - Street 1:103 TALMADGE DR
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-5050
Practice Address - Country:US
Practice Address - Phone:229-891-2442
Practice Address - Fax:229-890-9826
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023684183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist