Provider Demographics
NPI:1780752279
Name:BRANSTETTER, LANNY GENE (RPH)
Entity type:Individual
Prefix:MR
First Name:LANNY
Middle Name:GENE
Last Name:BRANSTETTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HORSE CAVE
Mailing Address - State:KY
Mailing Address - Zip Code:42749-1168
Mailing Address - Country:US
Mailing Address - Phone:270-786-2466
Mailing Address - Fax:270-786-1349
Practice Address - Street 1:141 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HORSE CAVE
Practice Address - State:KY
Practice Address - Zip Code:42749-1168
Practice Address - Country:US
Practice Address - Phone:270-786-2466
Practice Address - Fax:270-786-1349
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
KY006029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1805413OtherNABP
KY54009147Medicaid
KY9004052Medicaid
KY0156940001Medicare ID - Type Unspecified