Healthcare Provider Details

I. General information

NPI: 1083840425
Provider Name (Legal Business Name): BRANTLEY MICHAEL UNDERWOOD PHARMD, CSP, BCACP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 MITCHELL AVE
COOKEVILLE TN
38501-1852
US

IV. Provider business mailing address

1030 MITCHELL AVE
COOKEVILLE TN
38501-1852
US

V. Phone/Fax

Practice location:
  • Phone: 629-206-1040
  • Fax: 206-504-7792
Mailing address:
  • Phone: 629-206-1040
  • Fax: 206-504-7792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberR-16138
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number117751
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPD13265
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPH60661034
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number44702
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: