Provider Demographics
NPI:1902472079
Name:BRANTLEY, ANDRIA FRAZIER (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:FRAZIER
Last Name:BRANTLEY
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 1:7921 CORKFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5081
Mailing Address - Country:US
Mailing Address - Phone:321-320-1937
Mailing Address - Fax:
Practice Address - Street 1:7921 CORKFIELD AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5081
Practice Address - Country:US
Practice Address - Phone:321-320-1937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS52431Medicaid