Provider Demographics
NPI:1679779185
Name:BRASHEARS VITAL CARE CORP
Entity type:Organization
Organization Name:BRASHEARS VITAL CARE CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASHEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-637-2079
Mailing Address - Street 1:471 N DACIE PT
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461
Mailing Address - Country:US
Mailing Address - Phone:352-746-3420
Mailing Address - Fax:352-746-6741
Practice Address - Street 1:471 N DACIE PT
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461
Practice Address - Country:US
Practice Address - Phone:352-746-3420
Practice Address - Fax:352-746-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH227303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0290800002Medicare NSC