Provider Demographics
NPI:1427652965
Name:BRASHEARS, MAKAYLA (PHARMD)
Entity type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:
Last Name:BRASHEARS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 RIVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37879-6361
Mailing Address - Country:US
Mailing Address - Phone:865-585-2113
Mailing Address - Fax:
Practice Address - Street 1:1410 N BROAD ST
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37879-4350
Practice Address - Country:US
Practice Address - Phone:423-626-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY021525183500000X
TN44257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist