Provider Demographics
NPI:1730438250
Name:BRAINARD, CHARLES WADE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WADE
Last Name:BRAINARD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-3216
Mailing Address - Country:US
Mailing Address - Phone:864-665-5001
Mailing Address - Fax:864-665-5002
Practice Address - Street 1:508 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3216
Practice Address - Country:US
Practice Address - Phone:864-414-7993
Practice Address - Fax:864-665-5002
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist