Provider Demographics
NPI:1598301319
Name:BRAGANZA, BENEDICTO
Entity Type:Individual
Prefix:MR
First Name:BENEDICTO
Middle Name:
Last Name:BRAGANZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49461 OXLEY RD
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-1520
Mailing Address - Country:US
Mailing Address - Phone:586-864-3787
Mailing Address - Fax:
Practice Address - Street 1:26233 HOOVER RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48089-1100
Practice Address - Country:US
Practice Address - Phone:586-754-1191
Practice Address - Fax:586-754-0623
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist