Provider Demographics
NPI:1104102136
Name:BRANDS, MARY K (PHARM D)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:BRANDS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 FOREST VIEW RD
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7786
Mailing Address - Country:US
Mailing Address - Phone:920-233-3320
Mailing Address - Fax:
Practice Address - Street 1:1100 EMMERS LN
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7758
Practice Address - Country:US
Practice Address - Phone:920-235-4753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11382-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11382-40OtherLICENSE