Provider Demographics
NPI:1750785374
Name:QUILLEN, BRANDON (PHARMD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:QUILLEN
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 1:265 HIGHLAND SQ
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-5105
Mailing Address - Country:US
Mailing Address - Phone:931-456-7647
Mailing Address - Fax:
Practice Address - Street 1:265 HIGHLAND SQ
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5105
Practice Address - Country:US
Practice Address - Phone:931-456-7647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-09
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist