Individual
BREANNE FAIRBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
1900 MAIN ST, FRANKLINTON, LA 70438-3688
(985) 795-4116
(985) 795-4227
Mailing address
1900 MAIN ST, FRANKLINTON, LA 70438-3688
(985) 795-4116
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
E-010809
MS
183500000X
Pharmacist
Primary
PST.019246
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E-010809
MISSISSIPPI BOARD OF PHARMACY
MS
01
—
PST.019246
LOUISIANA BOARD OF PHARMACY
LA
Enumeration date
10/05/2018
Last updated
10/05/2018
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