Provider Demographics
NPI:1083840425
Name:UNDERWOOD, BRANTLEY MICHAEL (PHARMD, CSP, BCACP)
Entity type:Individual
Prefix:DR
First Name:BRANTLEY
Middle Name:MICHAEL
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:PHARMD, CSP, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 W BOCKMAN WAY
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1832
Mailing Address - Country:US
Mailing Address - Phone:931-836-3230
Mailing Address - Fax:931-836-3241
Practice Address - Street 1:483 W BOCKMAN WAY
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1832
Practice Address - Country:US
Practice Address - Phone:931-836-3230
Practice Address - Fax:931-836-3241
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD132651835P2201X
OKR-161381835P2201X
AK1177511835P2201X
WAPH606610341835P2201X
TN447021835P2201X
TN61539691835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care