Provider Demographics
NPI:1740576578
Name:BREWER, OSRIC S
Entity type:Individual
Prefix:
First Name:OSRIC
Middle Name:S
Last Name:BREWER
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 1:9601 W HIGHWAY 318
Mailing Address - Street 2:
Mailing Address - City:REDDICK
Mailing Address - State:FL
Mailing Address - Zip Code:32686-2220
Mailing Address - Country:US
Mailing Address - Phone:352-620-4724
Mailing Address - Fax:
Practice Address - Street 1:9601 W HIGHWAY 318
Practice Address - Street 2:
Practice Address - City:REDDICK
Practice Address - State:FL
Practice Address - Zip Code:32686-2220
Practice Address - Country:US
Practice Address - Phone:352-620-4724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13066183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist