Provider Demographics
NPI:1962785246
Name:BRAID, JEFFREY JAMES (RPH)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JAMES
Last Name:BRAID
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:6700 WHITMORE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2160
Mailing Address - Country:US
Mailing Address - Phone:810-220-8977
Mailing Address - Fax:810-220-8974
Practice Address - Street 1:6700 WHITMORE LAKE RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2160
Practice Address - Country:US
Practice Address - Phone:810-220-8977
Practice Address - Fax:810-220-8974
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027821183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist