Provider Demographics
NPI:1235522038
Name:LOWE, BRECK (PRESIDENT)
Entity Type:Individual
Prefix:
First Name:BRECK
Middle Name:
Last Name:LOWE
Suffix:
Gender:M
Credentials:PRESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1829 SERENA DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134-2233
Mailing Address - Country:US
Mailing Address - Phone:469-688-7335
Mailing Address - Fax:
Practice Address - Street 1:1829 SERENA DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-2233
Practice Address - Country:US
Practice Address - Phone:469-688-7335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes132700000XDietary & Nutritional Service ProvidersDietary Manager