Provider Demographics
NPI:1023845674
Name:BREEDLOVE, GARRETT (PHARM D)
Entity type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:
Last Name:BREEDLOVE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5154 KNICKERBOCKER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-7714
Mailing Address - Country:US
Mailing Address - Phone:325-276-6620
Mailing Address - Fax:325-276-6619
Practice Address - Street 1:5154 KNICKERBOCKER RD
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-7714
Practice Address - Country:US
Practice Address - Phone:325-276-6620
Practice Address - Fax:325-276-6619
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist