Provider Demographics
NPI:1255574539
Name:BURKHOLDER, BRANDON REID (PHARMD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:REID
Last Name:BURKHOLDER
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 1:16495 FREED ST SE
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-9106
Mailing Address - Country:US
Mailing Address - Phone:330-868-7063
Mailing Address - Fax:
Practice Address - Street 1:8619 WAYNESBURG DR SE
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:OH
Practice Address - Zip Code:44688-9549
Practice Address - Country:US
Practice Address - Phone:330-866-5020
Practice Address - Fax:330-866-9096
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-28034183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist