Provider Demographics
NPI:1861704967
Name:BRAZER, MARCIE JOANNE
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:JOANNE
Last Name:BRAZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 BAYBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-3108
Mailing Address - Country:US
Mailing Address - Phone:724-452-0881
Mailing Address - Fax:
Practice Address - Street 1:1130 PERRY HWY
Practice Address - Street 2:SUITE 35
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-2142
Practice Address - Country:US
Practice Address - Phone:412-369-4267
Practice Address - Fax:412-369-8041
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-039260-L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist