Provider Demographics
NPI:1366744898
Name:BANKIERIS, BRANDON ROBERT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:ROBERT
Last Name:BANKIERIS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 ROCK SPRINGS CT NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2327
Mailing Address - Country:US
Mailing Address - Phone:912-308-8992
Mailing Address - Fax:
Practice Address - Street 1:106 ROCK QUARRY RD STE A
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3766
Practice Address - Country:US
Practice Address - Phone:770-507-1559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-05
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist