Provider Demographics
NPI:1780967737
Name:BRASHER, JONATHAN BRETT (RPH)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:BRETT
Last Name:BRASHER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-1718
Mailing Address - Country:US
Mailing Address - Phone:270-527-8346
Mailing Address - Fax:
Practice Address - Street 1:521 LONE OAK RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4543
Practice Address - Country:US
Practice Address - Phone:270-442-6659
Practice Address - Fax:270-442-8982
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY010409OtherSTATE LICENSE NUMBER