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NPI Code Detail

MEDICARE: BRAXTON DEFRIEZ PHARMD

MEDICARE: BRAXTON DEFRIEZ PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P1200XPharmacotherapy Pharmacist10919437-1701UT

General Provider Information

NPI Number : 1669330114
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRAXTON DEFRIEZ PHARMD
Provider Business Mailing Address
First Line : 4401 HARRISON BLVD
Second Line :
City : OGDEN
State : UT
Zip : 84403-3195
Country : US
Telephone Number : 801-387-6007
Fax Number : 801-387-6022
Provider Business Practice Location Address
First Line : 4401 HARRISON BLVD
Second Line :
City : OGDEN
State : UT
Zip : 84403-3195
Country : US
Telephone Number : 801-387-6008
Fax Number : 801-387-6022
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2026
Last Update Date : 01/13/2026

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Directions to “ BRAXTON DEFRIEZ PHARMD” Practice Location

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