Provider Demographics
NPI:1699930883
Name:BRANTLEY, HEIDI PRINCE (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:PRINCE
Last Name:BRANTLEY
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 1:2106 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2144
Mailing Address - Country:US
Mailing Address - Phone:919-491-3758
Mailing Address - Fax:
Practice Address - Street 1:4441 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5729
Practice Address - Country:US
Practice Address - Phone:919-534-1393
Practice Address - Fax:919-534-1288
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist