Healthcare Provider Details

I. General information

NPI: 1184157463
Provider Name (Legal Business Name): BRANDON HARRIS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 12/26/2022
Certification Date: 12/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 FURYS FERRY RD
AUGUSTA GA
30907-8945
US

IV. Provider business mailing address

672 FURYS FERRY RD
AUGUSTA GA
30907-8945
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-4277
  • Fax: 706-733-1917
Mailing address:
  • Phone: 706-733-4277
  • Fax: 706-210-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number029419
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: