MEDICARE: LARRY BRANCH RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	RPH029626	GA

General Provider Information

NPI Number	:	1104236595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY BRANCH RPH

Provider Business Mailing Address
First Line	:	3030 HEADLAND DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-5439
Country	:	US
Telephone Number	:	404-344-5383
Fax Number	:	404-344-4459

Provider Business Practice Location Address
First Line	:	3030 HEADLAND DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-5439
Country	:	US
Telephone Number	:	404-344-5383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2014
Last Update Date	:	06/03/2026

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