Provider Demographics
NPI:1063747558
Name:AVERETT, BRANDI (RPH)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:AVERETT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 POPLAR TENT RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7757
Mailing Address - Country:US
Mailing Address - Phone:704-784-1977
Mailing Address - Fax:704-784-1984
Practice Address - Street 1:5230 POPLAR TENT RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-7757
Practice Address - Country:US
Practice Address - Phone:704-784-1977
Practice Address - Fax:704-784-1984
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12982183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist