Provider Demographics
NPI:1902276231
Name:BRANDY PHARMACY CORP
Entity Type:Organization
Organization Name:BRANDY PHARMACY CORP
Other - Org Name:BRANDY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
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:214-707-9971
Mailing Address - Fax:
Practice Address - Street 1:2241 PEGGY LN STE B
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5709
Practice Address - Country:US
Practice Address - Phone:972-272-6300
Practice Address - Fax:972-272-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX354441301Medicaid