Provider Demographics
NPI:1215517693
Name:NELSON, BRAWN (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:BRAWN
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 S FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-3221
Mailing Address - Country:US
Mailing Address - Phone:561-450-3021
Mailing Address - Fax:561-450-3022
Practice Address - Street 1:3155 S FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3221
Practice Address - Country:US
Practice Address - Phone:561-450-3021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT71429183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician