Healthcare Provider Details

I. General information

NPI: 1831430677
Provider Name (Legal Business Name): BRIAN FAGAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14028 HIGHWAY 183
AUSTIN TX
78717
US

IV. Provider business mailing address

14028 NORTH US 183
AUSTIN TX
78717
US

V. Phone/Fax

Practice location:
  • Phone: 512-249-9886
  • Fax: 512-249-9850
Mailing address:
  • Phone: 512-249-9886
  • Fax: 512-249-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number50019
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: