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General NPI Number Information
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NPI Number | 1750579892
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Entity Type | Organization
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Legal Business Name | BRAUN PHARMA, LLC
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 05/01/2020
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Provider Practice Location Address
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Address Line | 1919 N CLYBOURN AVE
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City | CHICAGO
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State | IL
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Zip | 60614
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Country | US
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Telephone | 773-549-0634
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Fax | 773-549-2753
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Provider Business Mailing Address
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Address Line | 1919 N CLYBOURN AVE
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City | CHICAGO
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State | IL
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Zip | 60614
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Country | US
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Telephone | 773-549-0634
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Fax | 773-549-2753
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Authorized Official
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Title or Position | PHARMACIST-RN-CHARGE
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Name | SHARRON SUSAN SEYMOUR
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Credential |
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Telephone | 773-549-0634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 054.016333
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License Number State | IL
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