Provider Demographics
NPI:1952781130
Name:BRANNON, SARAH (RPH)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BRANNON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S MADERA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-3203
Mailing Address - Country:US
Mailing Address - Phone:559-674-8553
Mailing Address - Fax:559-674-0947
Practice Address - Street 1:402 S MADERA AVE STE A
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-3203
Practice Address - Country:US
Practice Address - Phone:559-674-8553
Practice Address - Fax:559-674-0947
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist