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General NPI Number Information
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NPI Number | 1174128995
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Entity Type | Individual
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Provider Name | BRYAN ABRAHAM
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Gender | Male
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 7102 CAMPBELL RD
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City | DALLAS
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State | TX
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Zip | 75248-1503
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Country | US
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Telephone | 972-931-7045
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Fax |
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Provider Business Mailing Address
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Address Line | 1812 AUBURN DR
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City | CARROLLTON
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State | TX
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Zip | 75007-1451
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 63258
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License Number State | TX
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