Healthcare Provider Details

I. General information

NPI: 1063716686
Provider Name (Legal Business Name): BRANDEN DEATON PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2010
Last Update Date: 12/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 N. MAIN STREET
TUBA CITY AZ
86045
US

IV. Provider business mailing address

P.O BOX 600 167 N. MAIN STREET
TUBA CITY AZ
86045
US

V. Phone/Fax

Practice location:
  • Phone: 928-283-2754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberP6425
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: