Individual
BRANDI KAYE LODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
5301 E GRANT RD, TUCSON, AZ 85712-2805
(520) 123-4567
Mailing address
1814 N SANTA ROSA AVE, TUCSON, AZ 85712-3531
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
022701
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126786
HOSPITAL
AZ
Enumeration date
01/18/2019
Last updated
01/18/2019
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