Healthcare Provider Details

I. General information

NPI: 1538096623
Provider Name (Legal Business Name): BRANDON PHILIP RA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 HUDSON INDUSTRIAL PKWY SUITE A
HUDSON OH
44236
US

IV. Provider business mailing address

5640 HUDSON INDUSTRIAL PKWY
HUDSON OH
44236-5011
US

V. Phone/Fax

Practice location:
  • Phone: 866-552-5522
  • Fax: 844-705-0156
Mailing address:
  • Phone: 866-552-5522
  • Fax: 844-705-0156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03338141
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: