Provider Demographics
NPI:1346577095
Name:BRUSTIE, GINA E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:E
Last Name:BRUSTIE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W FM 544
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-3913
Mailing Address - Country:US
Mailing Address - Phone:972-429-7949
Mailing Address - Fax:972-442-2059
Practice Address - Street 1:720 W FM 544
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3913
Practice Address - Country:US
Practice Address - Phone:972-429-7949
Practice Address - Fax:972-442-2059
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist