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NPI Code Detail

MEDICARE: BRANDY LEANN GAINES

MEDICARE: BRANDY LEANN GAINES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183700000XPharmacy TechnicianPT89535AR
2183500000XPharmacistPD11925AR

General Provider Information

NPI Number : 1235213539
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDY LEANN GAINES
Provider Business Mailing Address
First Line : 117 S 2ND ST
Second Line : PO BOX 497
City : AUGUSTA
State : AR
Zip : 72006-2309
Country : US
Telephone Number : 870-347-2534
Fax Number :
Provider Business Practice Location Address
First Line : 615 N MAIN ST
Second Line :
City : BRINKLEY
State : AR
Zip : 72021-2507
Country : US
Telephone Number : 870-734-1153
Fax Number : 870-734-1179
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 04/12/2013

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Directions to “ BRANDY LEANN GAINES ” Practice Location

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