Provider Demographics
NPI:1083840425
Name:UNDERWOOD, BRANTLEY MICHAEL (PHARMD, MBA, CSP)
Entity type:Individual
Prefix:DR
First Name:BRANTLEY
Middle Name:MICHAEL
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:PHARMD, MBA, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1852
Mailing Address - Country:US
Mailing Address - Phone:931-264-5381
Mailing Address - Fax:206-504-7792
Practice Address - Street 1:1030 MITCHELL AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1852
Practice Address - Country:US
Practice Address - Phone:931-264-5381
Practice Address - Fax:206-504-7792
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60661034183500000X
AK117751183500000X
TN44702183500000X
OKR-16138183500000X
ARPD13265183500000X
TN61539691835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist