Provider Demographics
NPI:1750951018
Name:DAVIDSON, BRANDY (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:MS
First Name:BRANDY
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:MS
Other - First Name:BRANDY
Other - Middle Name:
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:51037 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-4438
Mailing Address - Country:US
Mailing Address - Phone:586-739-1100
Mailing Address - Fax:586-739-5280
Practice Address - Street 1:51037 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-4438
Practice Address - Country:US
Practice Address - Phone:586-739-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303026608183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician