Provider Demographics
NPI:1730419441
Name:DAVIS, BRANDY GLYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:GLYNN
Last Name:DAVIS
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 1:1540 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SWEET HOME
Mailing Address - State:OR
Mailing Address - Zip Code:97386-1614
Mailing Address - Country:US
Mailing Address - Phone:541-367-0675
Mailing Address - Fax:541-367-0678
Practice Address - Street 1:1540 MAIN ST
Practice Address - Street 2:
Practice Address - City:SWEET HOME
Practice Address - State:OR
Practice Address - Zip Code:97386
Practice Address - Country:US
Practice Address - Phone:541-367-0675
Practice Address - Fax:541-367-0678
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00070315183500000X
ORRPH-00165011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist