Provider Demographics
NPI:1154863819
Name:PATCH, BRIGHTON E (PHARMD RPH)
Entity Type:Individual
Prefix:
First Name:BRIGHTON
Middle Name:E
Last Name:PATCH
Suffix:
Gender:F
Credentials:PHARMD RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 VINTAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7109
Mailing Address - Country:US
Mailing Address - Phone:907-523-2060
Mailing Address - Fax:907-523-2019
Practice Address - Street 1:3033 VINTAGE BLVD
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7109
Practice Address - Country:US
Practice Address - Phone:907-523-2060
Practice Address - Fax:907-523-2019
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-12
Last Update Date:2016-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK112426183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist