Provider Demographics
NPI:1568703635
Name:BRACERO, JAIME ROBERTO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:ROBERTO
Last Name:BRACERO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-2141
Mailing Address - Country:US
Mailing Address - Phone:386-747-0568
Mailing Address - Fax:
Practice Address - Street 1:1406 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-2141
Practice Address - Country:US
Practice Address - Phone:386-747-0568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 416221835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist