Provider Demographics
NPI:1992254049
Name:BRANTLEY, KAYREN SHIVER (RPH)
Entity type:Individual
Prefix:MRS
First Name:KAYREN
Middle Name:SHIVER
Last Name:BRANTLEY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 ALBEMARLE RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371-3102
Mailing Address - Country:US
Mailing Address - Phone:910-572-2129
Mailing Address - Fax:910-572-9606
Practice Address - Street 1:436 ALBEMARLE RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-3102
Practice Address - Country:US
Practice Address - Phone:910-572-2129
Practice Address - Fax:910-572-9606
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1871529099Medicaid