=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710451034
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRAHMANI HEALTH CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2019
-----------------------------------------------------
Last Update Date | 08/16/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2215 W BERRY ST
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76110-2804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-367-9244
-----------------------------------------------------
Fax | 817-367-9242
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2215 W BERRY ST
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76110-2804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-367-9244
-----------------------------------------------------
Fax | 817-367-9242
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. AARON SALVADOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-367-9244
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------