MEDICARE: DR. JOSHUA O. BRANNEN III PHARMD

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
1	183500000X	Pharmacist	RPH020025	GA

General Provider Information

NPI Number	:	1891722534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA O. BRANNEN III PHARMD

Provider Business Mailing Address
First Line	:	514 WASHINGTON AVE
Second Line	:
City	:	SANDERSVILLE
State	:	GA
Zip	:	31082-1971
Country	:	US
Telephone Number	:	478-552-6111
Fax Number	:	478-552-6113

Provider Business Practice Location Address
First Line	:	514 WASHINGTON AVE
Second Line	:
City	:	SANDERSVILLE
State	:	GA
Zip	:	31082-1971
Country	:	US
Telephone Number	:	478-552-6111
Fax Number	:	478-552-6113

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	07/08/2007

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