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General NPI Number Information
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NPI Number | 1679779185
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Entity Type | Organization
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Legal Business Name | BRASHEARS VITAL CARE CORP
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 471 N DACIE PT
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City | LECANTO
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State | FL
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Zip | 34461
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Country | US
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Telephone | 352-746-3420
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Fax | 352-746-6741
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Provider Business Mailing Address
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Address Line | 471 N DACIE PT
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City | LECANTO
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State | FL
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Zip | 34461
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Country | US
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Telephone | 352-746-3420
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Fax | 352-746-6741
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Authorized Official
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Title or Position | DIRECTOR
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Name | JESSE BRASHEAR
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Credential |
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Telephone | 352-637-2079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH22730
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License Number State | FL
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