Healthcare Provider Details

I. General information

NPI: 1780752279
Provider Name (Legal Business Name): LANNY GENE BRANSTETTER RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E MAIN ST
HORSE CAVE KY
42749-1168
US

IV. Provider business mailing address

141 E MAIN ST
HORSE CAVE KY
42749-1168
US

V. Phone/Fax

Practice location:
  • Phone: 270-786-2466
  • Fax: 270-786-1349
Mailing address:
  • Phone: 270-786-2466
  • Fax: 270-786-1349

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 Code183500000X
TaxonomyPharmacist
License Number006029
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: