Provider Demographics
NPI:1487953279
Name:MEHAFFIE, BRANDAN DAVID
Entity type:Individual
Prefix:
First Name:BRANDAN
Middle Name:DAVID
Last Name:MEHAFFIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 W CHOCOLATE AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-1674
Mailing Address - Country:US
Mailing Address - Phone:717-533-2941
Mailing Address - Fax:717-534-0692
Practice Address - Street 1:337 W CHOCOLATE AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-1674
Practice Address - Country:US
Practice Address - Phone:717-533-2941
Practice Address - Fax:717-534-0692
Is Sole Proprietor?:No
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044877L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist