Basic Information
| Provider Information | |||||||||
| NPI: | 1528161478 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRANHAM | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28951 MEADOWVIEW DR | ||||||||
| Address2: | |||||||||
| City: | POTEAU | ||||||||
| State: | OK | ||||||||
| PostalCode: | 749538744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185677012 | ||||||||
| FaxNumber: | 9185677037 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE CHOCTAW WAY | ||||||||
| Address2: | CHOCTAW NATION HEALTH CENTER | ||||||||
| City: | TALIHINA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9185677012 | ||||||||
| FaxNumber: | 9185677037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 11463 | OK | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.