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General NPI Number Information
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NPI Number | 1710684295
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Entity Type | Organization
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Legal Business Name | BRANDEDMED RX LLC
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Dates
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Enumeration Date | 02/14/2023
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 4150 OLD MILTON PKWY # 113-114
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City | ALPHARETTA
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State | GA
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Zip | 30005-3734
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Country | US
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Telephone | 801-400-8773
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Fax |
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Provider Business Mailing Address
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Address Line | 4150 OLD MILTON PKWY # 113-114
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City | ALPHARETTA
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State | GA
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Zip | 30005-3734
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Country | US
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Telephone | 801-400-8773
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAVIER VACA LUNA
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Credential |
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Telephone | 801-400-8773
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty 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 | 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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