Provider Demographics
NPI:1952905671
Name:BRANN, MICHELLE GARDNER
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GARDNER
Last Name:BRANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-3503
Mailing Address - Country:US
Mailing Address - Phone:804-648-0108
Mailing Address - Fax:804-643-3470
Practice Address - Street 1:1007 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3503
Practice Address - Country:US
Practice Address - Phone:804-648-0108
Practice Address - Fax:804-643-3470
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202011744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist