Provider Demographics
NPI:1457940751
Name:FAULDS, BRANDON C
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:C
Last Name:FAULDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12860 RESEARCH BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-3222
Mailing Address - Country:US
Mailing Address - Phone:512-506-9250
Mailing Address - Fax:512-506-9060
Practice Address - Street 1:12860 RESEARCH BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-3222
Practice Address - Country:US
Practice Address - Phone:512-506-9250
Practice Address - Fax:512-506-8581
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100734183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician