Provider Demographics
NPI:1316162753
Name:BRAZZALE, JAMES ALLEN (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ALLEN
Last Name:BRAZZALE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 MONNA ST
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-5424
Mailing Address - Country:US
Mailing Address - Phone:630-466-9505
Mailing Address - Fax:
Practice Address - Street 1:119 MONNA ST
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-5424
Practice Address - Country:US
Practice Address - Phone:630-466-9505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist