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General NPI Number Information
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NPI Number | 1720012057
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Entity Type | Individual
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Provider Name | BRANDALL LOVVORN RPH. PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 404 ALABAMA AVE S
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City | BREMEN
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State | GA
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Zip | 30110-2006
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Country | US
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Telephone | 770-537-8889
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Fax | 770-537-8817
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Provider Business Mailing Address
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Address Line | PO BOX 603
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City | BREMEN
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State | GA
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Zip | 30110-0603
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Country | US
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Telephone | 770-537-8889
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Fax | 770-537-8817
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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 | 8702
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License Number State | GA
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