Healthcare Provider Details

I. General information

NPI: 1073955100
Provider Name (Legal Business Name): BRIANNE MARIE PARRA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6802 EAST PASS APT 211
MADISON WI
53719-5632
US

IV. Provider business mailing address

6802 EAST PASS APT 211
MADISON WI
53719-5632
US

V. Phone/Fax

Practice location:
  • Phone: 708-691-1211
  • Fax:
Mailing address:
  • Phone: 708-691-1211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number051296637
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: