Provider Demographics
NPI:1326364498
Name:BRASHEAR, LAWRENCE SIMMS (RPH)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:SIMMS
Last Name:BRASHEAR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9127 WILD TRAILS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-3018
Mailing Address - Country:US
Mailing Address - Phone:210-364-4104
Mailing Address - Fax:
Practice Address - Street 1:7802 WURZBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4448
Practice Address - Country:US
Practice Address - Phone:210-614-3590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist