Provider Demographics
NPI:1174124531
Name:RAINS, BRANDY RENEE (PHARMD)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:RENEE
Last Name:RAINS
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 1:1002 W TAFT AVE
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-8799
Mailing Address - Country:US
Mailing Address - Phone:918-224-2800
Mailing Address - Fax:918-227-3752
Practice Address - Street 1:1002 W TAFT AVE
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-8720
Practice Address - Country:US
Practice Address - Phone:918-224-2800
Practice Address - Fax:918-227-3752
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist