Healthcare Provider Details

I. General information

NPI: 1295648475
Provider Name (Legal Business Name): PAIGE BRAZILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 NEW BRITAIN AVE
WEST HARTFORD CT
06110-2418
US

IV. Provider business mailing address

465 BUCKLAND HILLS DR APT 22112
MANCHESTER CT
06042-9102
US

V. Phone/Fax

Practice location:
  • Phone: 860-236-6181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCT.0017432
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: