Provider Demographics
NPI:1285298877
Name:BRASHEAR, MELANIE MERCER (RPH)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:MERCER
Last Name:BRASHEAR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 FM 449
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-9265
Mailing Address - Country:US
Mailing Address - Phone:903-680-2600
Mailing Address - Fax:903-260-2605
Practice Address - Street 1:825 US HIGHWAY 271 N
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644-5580
Practice Address - Country:US
Practice Address - Phone:903-680-2600
Practice Address - Fax:903-680-2605
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX290228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist