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General NPI Number Information
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NPI Number | 1669330114
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Entity Type | Individual
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Provider Name | BRAXTON DEFRIEZ PHARMD
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Gender | Male
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Dates
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Enumeration Date | 01/13/2026
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 4401 HARRISON BLVD
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City | OGDEN
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State | UT
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Zip | 84403-3195
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Country | US
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Telephone | 801-387-6008
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Fax | 801-387-6022
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Provider Business Mailing Address
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Address Line | 4401 HARRISON BLVD
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City | OGDEN
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State | UT
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Zip | 84403-3195
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Country | US
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Telephone | 801-387-6007
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Fax | 801-387-6022
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 10919437-1701
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License Number State | UT
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