Provider Demographics
NPI:1174229694
Name:BRIGHAM, ACQUELLA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ACQUELLA
Middle Name:
Last Name:BRIGHAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 E GLENWOOD LANSING RD APT 1B
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-1955
Mailing Address - Country:US
Mailing Address - Phone:773-595-5088
Mailing Address - Fax:
Practice Address - Street 1:3153 183RD ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2806
Practice Address - Country:US
Practice Address - Phone:708-799-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051305287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist