Provider Demographics
NPI:1356850341
Name:BRAZZEL, MORGAN (PHARM D)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:BRAZZEL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:BERNICE
Mailing Address - State:LA
Mailing Address - Zip Code:71222-0636
Mailing Address - Country:US
Mailing Address - Phone:318-285-9521
Mailing Address - Fax:318-285-0185
Practice Address - Street 1:417 E 4TH STREET
Practice Address - Street 2:
Practice Address - City:BERNICE
Practice Address - State:LA
Practice Address - Zip Code:71222
Practice Address - Country:US
Practice Address - Phone:318-285-9521
Practice Address - Fax:318-285-0185
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.022053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist