Provider Demographics
NPI:1124742044
Name:BRANNON, MALOREY (PHARM D)
Entity type:Individual
Prefix:
First Name:MALOREY
Middle Name:
Last Name:BRANNON
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 1:731 N MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2912
Mailing Address - Country:US
Mailing Address - Phone:870-741-2119
Mailing Address - Fax:870-741-5572
Practice Address - Street 1:731 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2912
Practice Address - Country:US
Practice Address - Phone:870-741-2119
Practice Address - Fax:870-741-5572
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist