Provider Demographics
NPI:1497231328
Name:BRANDY PHARMACY CORP
Entity Type:Organization
Organization Name:BRANDY PHARMACY CORP
Other - Org Name:BRANDY PHARMACY 4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEDAL
Authorized Official - Middle Name:
Authorized Official - Last Name:NASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-992-8205
Mailing Address - Street 1:PO BOX 851766
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-1766
Mailing Address - Country:US
Mailing Address - Phone:972-992-8205
Mailing Address - Fax:
Practice Address - Street 1:910 N GALLOWAY AVE STE 102-A
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2409
Practice Address - Country:US
Practice Address - Phone:972-992-8205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy