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NPI Code Detail

MEDICARE: BRASWELL DRUGS INC

MEDICARE: BRASWELL DRUGS INC
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
1333600000XPharmacy
23336C0003XCommunity/Retail PharmacyPHY.001646-IRLA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12031009OTHERPK
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972651974
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRASWELL DRUGS INC
Provider Business Mailing Address
First Line : 1107 S TYLER ST
Second Line :
City : COVINGTON
State : LA
Zip : 70433-2327
Country : US
Telephone Number : 985-892-0818
Fax Number : 985-892-2742
Provider Business Practice Location Address
First Line : 1107 S TYLER ST
Second Line :
City : COVINGTON
State : LA
Zip : 70433-2327
Country : US
Telephone Number : 985-892-0818
Fax Number : 985-892-2742
Authorized Official
Title or Position : OWNER
Name : WANDA BRASWELL
Credential :
Telephone Number : 985-892-0818
Provider Enumeration Date : 01/08/2007
Last Update Date : 12/22/2016

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Directions to “BRASWELL DRUGS INC ” Practice Location

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