Healthcare Provider Details

I. General information

NPI: 1902915911
Provider Name (Legal Business Name): JENNIFER LEIGH BRANCH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 W MAIN ST
DOTHAN AL
36301-1217
US

IV. Provider business mailing address

226 W REEVES ST
SLOCOMB AL
36375-4868
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-1126
  • Fax:
Mailing address:
  • Phone: 334-671-7799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS32003
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14540
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: