Provider Demographics
NPI:1679304505
Name:BLACKBURN, BRANDON LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:LEE
Last Name:BLACKBURN
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 1:612 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-6606
Mailing Address - Country:US
Mailing Address - Phone:336-681-4602
Mailing Address - Fax:
Practice Address - Street 1:904 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-3924
Practice Address - Country:US
Practice Address - Phone:336-887-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist