Provider Demographics
NPI:1881976769
Name:SMITH, BRANDON (PHARMD)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:SMITH
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 1:5401 S HYDE PARK BLVD
Mailing Address - Street 2:APARTMENT 1004
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-5829
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5401 S HYDE PARK BLVD
Practice Address - Street 2:APARTMENT 1004
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-5829
Practice Address - Country:US
Practice Address - Phone:312-545-3306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.294523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist