Provider Demographics
NPI:1730391178
Name:BRANTLEY, K (BS PHARMACY)
Entity type:Individual
Prefix:MS
First Name:K
Middle Name:
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MCGEHEE
Mailing Address - State:AR
Mailing Address - Zip Code:71654-1606
Mailing Address - Country:US
Mailing Address - Phone:630-985-7333
Mailing Address - Fax:
Practice Address - Street 1:2045 HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-1909
Practice Address - Country:US
Practice Address - Phone:985-626-9726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA108541835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric