| NPI | 1013254176 |
|---|---|
| Former Name | BRANDON V THACH |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps39614) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA ph23820) |
| Enumeration Date | 2013-01-09 |
| Last Update Date | 2013-01-09 |