Provider Demographics
NPI:1992343891
Name:HALE, BRANDON (PHARMD, KY LDE)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:HALE
Suffix:
Gender:M
Credentials:PHARMD, KY LDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4004
Mailing Address - Country:US
Mailing Address - Phone:270-443-9459
Mailing Address - Fax:270-443-9465
Practice Address - Street 1:3141 PARK AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4004
Practice Address - Country:US
Practice Address - Phone:270-443-9459
Practice Address - Fax:270-443-9465
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY015506183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist