Provider Demographics
NPI:1235711854
Name:FRAUSTO, BRANDON DAVID (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:DAVID
Last Name:FRAUSTO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 770
Mailing Address - Street 2:
Mailing Address - City:CLARENDON
Mailing Address - State:TX
Mailing Address - Zip Code:79226-0770
Mailing Address - Country:US
Mailing Address - Phone:806-874-3554
Mailing Address - Fax:806-874-9287
Practice Address - Street 1:501 W 2ND
Practice Address - Street 2:
Practice Address - City:CLARENDON
Practice Address - State:TX
Practice Address - Zip Code:79226
Practice Address - Country:US
Practice Address - Phone:806-874-3554
Practice Address - Fax:806-874-9287
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist