Healthcare Provider Details

I. General information

NPI: 1669236196
Provider Name (Legal Business Name): BRANDON HEER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 CULVER ST
COMMERCE TX
75428-3422
US

IV. Provider business mailing address

975 COUNTY ROAD 4131
CUMBY TX
75433-5194
US

V. Phone/Fax

Practice location:
  • Phone: 903-886-2867
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number72878
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: