Provider Demographics
NPI:1114520707
Name:BRUMFIELD, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BRUMFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4027 WATERFORD LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6948
Mailing Address - Country:US
Mailing Address - Phone:713-366-6048
Mailing Address - Fax:
Practice Address - Street 1:2781 DULLES AVE
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2984
Practice Address - Country:US
Practice Address - Phone:281-403-2269
Practice Address - Fax:281-403-6199
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47599183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist