Healthcare Provider Details

I. General information

NPI: 1609398981
Provider Name (Legal Business Name): BRANDON LUKE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2017
Last Update Date: 07/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5835 W INDIAN SCHOOL RD
PHOENIX AZ
85031-2420
US

IV. Provider business mailing address

5835 W INDIAN SCHOOL RD
PHOENIX AZ
85031-2420
US

V. Phone/Fax

Practice location:
  • Phone: 623-247-4030
  • Fax: 623-247-4036
Mailing address:
  • Phone: 623-247-4030
  • Fax: 623-247-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS022441
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: