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General NPI Number Information
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NPI Number | 1699131300
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Entity Type | Individual
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Provider Name | BRENT ALAN LOSIER PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 01/11/2016
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Last Update Date | 01/11/2016
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Provider Practice Location Address
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Address Line | 3537 N ANTHONY BLVD SUITE A
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City | FORT WAYNE
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State | IN
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Zip | 46805-1423
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Country | US
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Telephone | 260-373-1083
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Fax |
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Provider Business Mailing Address
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Address Line | 3515 N COUNTY LINE RD W
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City | HUNTERTOWN
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State | IN
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Zip | 46748-9489
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Country | US
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Telephone | 812-320-4000
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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 | 26018627A
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License Number State | IN
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