Healthcare Provider Details

I. General information

NPI: 1588675094
Provider Name (Legal Business Name): BRANSCOMB PHARMACY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 BRANSCOMB RD #1
LAYTONVILLE CA
95454-0016
US

IV. Provider business mailing address

PO BOX 16
LAYTONVILLE CA
95454-0016
US

V. Phone/Fax

Practice location:
  • Phone: 707-984-8370
  • Fax: 707-984-8372
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY47525
License Number StateCA

VIII. Authorized Official

Name: IBUKUN BANDELE
Title or Position: PRESIDENT
Credential: RPH
Phone: 707-984-8370