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General NPI Number Information
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NPI Number | 1841545670
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Entity Type | Individual
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Provider Name | JACQULIN SUZANNE BRANER PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 04/23/2014
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Provider Practice Location Address
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Address Line | 11050 MOUNT BELVEDERE BLVD
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City | FORT DRUM
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State | NY
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Zip | 13602-5438
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Country | US
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Telephone | 315-772-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 1106 HARRISON ST
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City | WATERTOWN
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State | NY
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Zip | 13601-3812
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Country | US
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Telephone | 618-960-5163
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 053930
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License Number State | NY
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