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General NPI Number Information
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NPI Number | 1811597057
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Entity Type | Individual
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Provider Name | MR. BRENTON DAVE HORNER
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Gender | Male
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Dates
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Enumeration Date | 10/27/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 1801 MARKETPLACE DR
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City | GARLAND
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State | TX
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Zip | 75041-5605
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Country | US
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Telephone | 972-279-8728
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Fax |
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Provider Business Mailing Address
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Address Line | 2716 ENID DR
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City | PLANO
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State | TX
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Zip | 75093-1909
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Country | US
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Telephone | 214-729-8967
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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 | 12621
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 38462
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License Number State | TX
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