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General NPI Number Information
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NPI Number | 1134694144
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Entity Type | Individual
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Provider Name | BREANNE FAIRBURN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/05/2018
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Last Update Date | 10/05/2018
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Provider Practice Location Address
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Address Line | 1900 MAIN ST
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City | FRANKLINTON
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State | LA
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Zip | 70438-3688
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Country | US
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Telephone | 985-795-4116
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Fax | 985-795-4227
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Provider Business Mailing Address
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Address Line | 1900 MAIN ST
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City | FRANKLINTON
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State | LA
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Zip | 70438-3688
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Country | US
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Telephone | 985-795-4116
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | E-010809
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PST.019246
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License Number State | LA
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