Provider Demographics
NPI:1942783238
Name:BRANNON, DESTINI R (PHARMD)
Entity type:Individual
Prefix:
First Name:DESTINI
Middle Name:R
Last Name:BRANNON
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 1:1410 JACKSON DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-4453
Mailing Address - Country:US
Mailing Address - Phone:404-915-4095
Mailing Address - Fax:
Practice Address - Street 1:2201 COBB PKWY SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7629
Practice Address - Country:US
Practice Address - Phone:770-952-2241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH030794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist