Provider Demographics
NPI:1518957877
Name:BRACE, NANCY MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:MARIE
Last Name:BRACE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:NANCY
Other - Middle Name:MARIE
Other - Last Name:BOGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13891 FAIRFAX ST
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-8347
Mailing Address - Country:US
Mailing Address - Phone:419-560-2617
Mailing Address - Fax:
Practice Address - Street 1:1800 VALLEY WEST DR
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1104
Practice Address - Country:US
Practice Address - Phone:515-225-3784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-25746183500000X
IA21916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7130661Medicaid
OH7130661Medicaid