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General NPI Number Information
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NPI Number | 1700157468
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Entity Type | Individual
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Provider Name | GARY ALAN BRANCH P.PH.
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Gender | Male
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | 5805 82ND ST
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City | LUBBOCK
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State | TX
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Zip | 79424-3618
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Country | US
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Telephone | 806-698-8462
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Fax | 806-798-9949
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Provider Business Mailing Address
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Address Line | 5710 84TH ST
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City | LUBBOCK
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State | TX
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Zip | 79424-4634
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Country | US
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Telephone | 806-790-7106
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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 | 28313
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License Number State | TX
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