Healthcare Provider Details

I. General information

NPI: 1235711854
Provider Name (Legal Business Name): BRANDON DAVID FRAUSTO PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 04/23/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W 2ND
CLARENDON TX
79226
US

IV. Provider business mailing address

PO BOX 770
CLARENDON TX
79226-0770
US

V. Phone/Fax

Practice location:
  • Phone: 806-874-3554
  • Fax: 806-874-9287
Mailing address:
  • Phone: 806-874-3554
  • Fax: 806-874-9287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54874
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: