Healthcare Provider Details

I. General information

NPI: 1548873060
Provider Name (Legal Business Name): DAVID QUENTEN BRANNON II PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2471 JACKSON AVE
MEMPHIS TN
38108-3318
US

IV. Provider business mailing address

122 GAYOSO AVE APT 509
MEMPHIS TN
38103-2968
US

V. Phone/Fax

Practice location:
  • Phone: 901-454-1615
  • Fax:
Mailing address:
  • Phone: 901-288-4831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number44305
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: