Provider Demographics
NPI:1720688161
Name:BRANDON, TIMOTHY KELVIN (PHARMD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:KELVIN
Last Name:BRANDON
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 1:219 WOODBURN DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23664-1962
Mailing Address - Country:US
Mailing Address - Phone:757-593-4916
Mailing Address - Fax:
Practice Address - Street 1:2601 GEORGE WASHINGTON MEM HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-3409
Practice Address - Country:US
Practice Address - Phone:757-867-8281
Practice Address - Fax:757-867-9580
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202210057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist