Healthcare Provider Details

I. General information

NPI: 1255610291
Provider Name (Legal Business Name): BRANDY C BUTCHER PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CUMBERLAND PKWY SE
ATLANTA GA
30339-3915
US

IV. Provider business mailing address

2525 CUMBERLAND PKWY SE
ATLANTA GA
30339-3915
US

V. Phone/Fax

Practice location:
  • Phone: 770-431-4326
  • Fax: 770-431-4122
Mailing address:
  • Phone: 770-431-4326
  • Fax: 770-431-4122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH022393
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: