Provider Demographics
NPI:1336973254
Name:HERRON, BRIANNA (PHARM D)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:HERRON
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 1:7408 BRITTNAY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-8359
Mailing Address - Country:US
Mailing Address - Phone:901-567-0400
Mailing Address - Fax:
Practice Address - Street 1:7251 INTERSTATE BOULEVARD
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637
Practice Address - Country:US
Practice Address - Phone:662-349-8336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-1016901835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist