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General NPI Number Information
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NPI Number | 1568730091
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Entity Type | Individual
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Provider Name | JORDAN LYNN BRAZEAL PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 01/17/2014
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Provider Practice Location Address
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Address Line | 4010 S MULBERRY ST
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City | PINE BLUFF
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State | AR
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Zip | 71603-7000
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Country | US
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Telephone | 870-541-6044
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Fax | 870-541-7601
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Provider Business Mailing Address
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Address Line | 4010 S MULBERRY ST
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City | PINE BLUFF
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State | AR
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Zip | 71603-7000
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Country | US
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Telephone | 870-541-6044
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Fax | 870-541-7601
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PD11871
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License Number State | AR
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