=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811542582
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRANDON MICHAEL MCKINNEY PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2019
-----------------------------------------------------
Last Update Date | 08/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3402 CLARK AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44109-1136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-961-9414
-----------------------------------------------------
Fax | 216-651-8205
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8375 SHORTHORN DR
-----------------------------------------------------
City | SAGAMORE HILLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44067-3225
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-467-9635
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 03439091
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------