Provider Demographics
NPI:1578858478
Name:SISOLAK, BRIAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:SISOLAK
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 1:1004 N CROSS LN
Mailing Address - Street 2:APT B
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-3485
Mailing Address - Country:US
Mailing Address - Phone:702-525-9337
Mailing Address - Fax:
Practice Address - Street 1:7400 N 10TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-7700
Practice Address - Country:US
Practice Address - Phone:956-686-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49683183500000X
NV17927183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist