Provider Demographics
NPI:1174948467
Name:BRANDT, MARY BETH (RPH)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:BRANDT
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 1:303 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1625
Mailing Address - Country:US
Mailing Address - Phone:864-421-4836
Mailing Address - Fax:
Practice Address - Street 1:805 W WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1311
Practice Address - Country:US
Practice Address - Phone:864-655-6425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist