Healthcare Provider Details

I. General information

NPI: 1578321451
Provider Name (Legal Business Name): BREANNA BACA PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 E BASELINE RD
GILBERT AZ
85233-1545
US

IV. Provider business mailing address

1845 E BASELINE RD
GILBERT AZ
85233-1545
US

V. Phone/Fax

Practice location:
  • Phone: 480-539-3733
  • Fax:
Mailing address:
  • Phone: 480-539-3733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS026870
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: