Provider Demographics
NPI:1316254816
Name:GROSS, BRANDON THOMAS (PHARMD)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:THOMAS
Last Name:GROSS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2827
Mailing Address - Country:US
Mailing Address - Phone:425-252-5196
Mailing Address - Fax:
Practice Address - Street 1:4920 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2827
Practice Address - Country:US
Practice Address - Phone:425-252-5196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60152117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist