Provider Demographics
NPI:1447707088
Name:BRANNEN, KAITLIN (PHARMD)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:BRANNEN
Suffix:
Gender:F
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:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:BROOKLET
Mailing Address - State:GA
Mailing Address - Zip Code:30415-0215
Mailing Address - Country:US
Mailing Address - Phone:912-842-9886
Mailing Address - Fax:912-842-9890
Practice Address - Street 1:114 B PARKER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLET
Practice Address - State:GA
Practice Address - Zip Code:30415
Practice Address - Country:US
Practice Address - Phone:912-842-9886
Practice Address - Fax:912-842-9890
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist