Provider Demographics
NPI:1548873060
Name:BRANNON, DAVID QUENTEN II (PHARMD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:QUENTEN
Last Name:BRANNON
Suffix:II
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 1:122 GAYOSO AVE APT 509
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2968
Mailing Address - Country:US
Mailing Address - Phone:901-288-4831
Mailing Address - Fax:
Practice Address - Street 1:2471 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38108-3318
Practice Address - Country:US
Practice Address - Phone:901-454-1615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN443051835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care