Provider Demographics
NPI:1417241837
Name:BRASWELL, ROXANNE ELIZABETH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNE
Middle Name:ELIZABETH
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 FANNIN ST
Mailing Address - Street 2:STE 105
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3815
Mailing Address - Country:US
Mailing Address - Phone:409-832-6100
Mailing Address - Fax:409-832-4848
Practice Address - Street 1:3515 FANNIN ST
Practice Address - Street 2:STE 105
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3815
Practice Address - Country:US
Practice Address - Phone:409-832-6100
Practice Address - Fax:409-832-4848
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-02
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29272183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist