Healthcare Provider Details

I. General information

NPI: 1710912662
Provider Name (Legal Business Name): BRASHEARS VITAL CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W DAMPIER ST
INVERNESS FL
34450-4212
US

IV. Provider business mailing address

206 W DAMPIER ST
INVERNESS FL
34450-4212
US

V. Phone/Fax

Practice location:
  • Phone: 352-637-2079
  • Fax: 352-637-7118
Mailing address:
  • Phone: 352-637-2079
  • Fax: 352-637-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH11407
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BRASHEAR
Title or Position: PRESIDENT
Credential:
Phone: 352-637-2079