Healthcare Provider Details

I. General information

NPI: 1114431848
Provider Name (Legal Business Name): FRANK A BRAVERMAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MARCELA DR
WILLITS CA
95490-5769
US

IV. Provider business mailing address

1540 ROAD D
REDWOOD VALLEY CA
95470-9794
US

V. Phone/Fax

Practice location:
  • Phone: 707-456-3005
  • Fax:
Mailing address:
  • Phone: 707-367-1458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number30606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: