Basic Information
| Provider Information | |||||||||
| NPI: | 1265565071 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRANNON | ||||||||
| FirstName: | ROSA | ||||||||
| MiddleName: | MARTHA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHARMD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DRANNON | ||||||||
| OtherFirstName: | MARTHA | ||||||||
| OtherMiddleName: | BETTIS | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PHARMD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2150 WHITNEY AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381276662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013535440 | ||||||||
| FaxNumber: | 9013535464 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 WHITNEY AVE | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381276662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013535440 | ||||||||
| FaxNumber: | 9013535464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835P1300X | 0000004238 | TN | Y | Pharmacy Service Providers | Pharmacist | Psychiatric |
No ID Information.