MEDICARE: MS. DANA BRAXTON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302039099	MI

General Provider Information

NPI Number	:	1821427592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANA BRAXTON PHARMD

Provider Business Mailing Address
First Line	:	1301 W 8 MILE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48203-1021
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 W 8 MILE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48203-1021
Country	:	US
Telephone Number	:	313-369-5210
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2013
Last Update Date	:	11/04/2013

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