Provider Demographics
NPI:1174114813
Name:BRAND, CARLY (PHARMD)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:BRAND
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 MONTE CRISTO BLVD
Mailing Address - Street 2:
Mailing Address - City:TIERRA VERDE
Mailing Address - State:FL
Mailing Address - Zip Code:33715-2006
Mailing Address - Country:US
Mailing Address - Phone:678-300-1397
Mailing Address - Fax:
Practice Address - Street 1:6499 38TH AVE N STE A1
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1658
Practice Address - Country:US
Practice Address - Phone:727-344-3902
Practice Address - Fax:727-343-1356
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist