Provider Demographics
NPI:1144771601
Name:LABOSSIERE, BRETT
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:LABOSSIERE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7989 MEADOW RUSH LOOP
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-4319
Mailing Address - Country:US
Mailing Address - Phone:941-323-2890
Mailing Address - Fax:
Practice Address - Street 1:3475 WEDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-7183
Practice Address - Country:US
Practice Address - Phone:352-751-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55514183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist