Healthcare Provider Details

I. General information

NPI: 1295336139
Provider Name (Legal Business Name): BRANDY M WRENN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MARKET PL
RICHLAND MS
39218-4429
US

IV. Provider business mailing address

263 HICKORY RIDGE RD
FLORENCE MS
39073-8753
US

V. Phone/Fax

Practice location:
  • Phone: 601-919-2958
  • Fax: 601-939-4489
Mailing address:
  • Phone: 901-515-8904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE13634
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE13936
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: