Provider Demographics
NPI:1912422536
Name:ROLAND, BRANDON MATHIAS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:MATHIAS
Last Name:ROLAND
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 1:921 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2309
Mailing Address - Country:US
Mailing Address - Phone:321-213-3052
Mailing Address - Fax:
Practice Address - Street 1:1108 LAKE DR
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-8678
Practice Address - Country:US
Practice Address - Phone:321-806-3951
Practice Address - Fax:321-806-4754
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist