Healthcare Provider Details

I. General information

NPI: 1154816106
Provider Name (Legal Business Name): JESSICA ARNETTE BRAZER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 PEACHTREE RD NE
ATLANTA GA
30326-1039
US

IV. Provider business mailing address

4739 ROSWELL RD
SANDY SPRINGS GA
30342-2901
US

V. Phone/Fax

Practice location:
  • Phone: 866-787-6341
  • Fax:
Mailing address:
  • Phone: 678-773-8229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRPH029565
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: