Brandon Derrick Marshall, PHARM.D.
Individual provider Active NPI Pharmacist · Tracy City, TN
NPI 1629375522 · NPPES record last updated May 15, 2013
Key facts
- NPI
- 1629375522
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 33171 (TN)
- Practice address
- 740 Main St
Tracy City, TN 37387-4020 - Phone
- (931) 592-9190
- Fax
- (931) 592-9203
- NPI assigned
- Feb 12, 2011
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33171 | TN | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 33171 | TN | Yes |
Addresses
Primary practice location
740 Main St
Tracy City, TN 37387-4020
Mailing address
412 Oak Ave
South Pittsburg, TN 37380-1236
Other providers in Tracy City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.