=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932590635
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JIMMIE LYNN BRANDON PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2015
-----------------------------------------------------
Last Update Date | 02/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3141 GARDEN RD
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-9786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-584-1133
-----------------------------------------------------
Fax | 336-584-4136
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3141 GARDEN RD
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27215-9786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-584-1133
-----------------------------------------------------
Fax | 336-584-4136
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 12491
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 7985
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------