Provider Demographics
NPI:1306175898
Name:BRINSON, CHARLES EDWARD JR
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:EDWARD
Last Name:BRINSON
Suffix:JR
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 1:5713 S FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79110-3238
Mailing Address - Country:US
Mailing Address - Phone:806-352-3705
Mailing Address - Fax:
Practice Address - Street 1:5921 HILLISIDE ROAD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109
Practice Address - Country:US
Practice Address - Phone:806-463-1057
Practice Address - Fax:806-463-3256
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23948183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist