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General NPI Number Information
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NPI Number | 1538104740
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Entity Type | Organization
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Legal Business Name | BRANCH ENTERPRISES
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 17490 SW 104TH AVE STE B
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City | MIAMI
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State | FL
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Zip | 33157-4200
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Country | US
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Telephone | 305-969-3353
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Fax | 305-969-3115
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Provider Business Mailing Address
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Address Line | 17490 SW 104TH AVE STE B
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City | MIAMI
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State | FL
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Zip | 33157-4200
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Country | US
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Telephone | 305-969-3353
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Fax | 305-969-3115
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Authorized Official
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Title or Position | PRESIDENT
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Name | EVANS BRANCH III
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Credential | PHARMD
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Telephone | 305-969-3353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH18244
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License Number State | FL
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