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General NPI Number Information
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NPI Number | 1497231328
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Entity Type | Organization
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Legal Business Name | BRANDY PHARMACY CORP
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 910 N GALLOWAY AVE STE 102-A
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City | MESQUITE
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State | TX
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Zip | 75149-2409
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Country | US
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Telephone | 972-992-8205
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 851766
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City | MESQUITE
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State | TX
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Zip | 75185-1766
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Country | US
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Telephone | 972-992-8205
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | NEDAL NASER
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Credential |
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Telephone | 972-992-8205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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