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NPI Code Detail

MEDICARE: BRAVE SOI PHARM.D.

MEDICARE: BRAVE SOI PHARM.D.
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
1183500000XPharmacist61404CA

General Provider Information

NPI Number : 1861947806
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRAVE SOI PHARM.D.
Provider Business Mailing Address
First Line : 1401 S BALDWIN AVE
Second Line :
City : ARCADIA
State : CA
Zip : 91007-7922
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1401 S BALDWIN AVE
Second Line :
City : ARCADIA
State : CA
Zip : 91007-7922
Country : US
Telephone Number : 626-445-1284
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2016
Last Update Date : 08/19/2016

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Directions to “ BRAVE SOI PHARM.D.” Practice Location

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