Provider Demographics
NPI:1215250782
Name:BRAGA, ELIZABETH (RPH)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BRAGA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 FREEDOM PLAINS RD
Mailing Address - Street 2:WALGREENS PHARMACY
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-6700
Mailing Address - Country:US
Mailing Address - Phone:845-452-2689
Mailing Address - Fax:
Practice Address - Street 1:704 FREEDOM PLAINS RD
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6700
Practice Address - Country:US
Practice Address - Phone:845-452-2689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist