Individual
SHANNON LEE BRANTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
90 HOPE DR BLDG 6000, 366 MDSS/SGSAP, MOUNTAIN HOME AFB, ID 83648-1062
(208) 828-7480
Mailing address
420 E 12TH NORTH, MOUNTAIN HOME, ID 83647
(208) 587-3658
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13742
AZ
Other
Enumeration date
09/20/2006
Last updated
07/08/2007
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