Provider Demographics
NPI:1508096371
Name:BRAXTON, RECENNAH DALEVETTA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RECENNAH
Middle Name:DALEVETTA
Last Name:BRAXTON
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 1:6604 ROCK LEDGE RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7683
Mailing Address - Country:US
Mailing Address - Phone:334-202-4003
Mailing Address - Fax:
Practice Address - Street 1:101 GREENVILLE BYP
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:AL
Practice Address - Zip Code:36037-3724
Practice Address - Country:US
Practice Address - Phone:334-202-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202209288183500000X
AL16369183500000X
MO2009025144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist