Individual
DR. BRANDON PAUL BOURGEOIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHARMD, RPH
Contact information
Practice address
9400 MENTOR AVE, MENTOR, OH 44060-4520
(440) 255-6247
(440) 255-7203
Mailing address
9400 MENTOR AVE, MENTOR, OH 44060-4520
(440) 255-6247
(440) 255-7203
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
03236547
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03236547
OHIO BOARD OF PHARMACY
OH
Enumeration date
06/17/2020
Last updated
06/17/2020
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