Provider Demographics
NPI:1740793595
Name:BRAZO PHARMACY LLC
Entity Type:Organization
Organization Name:BRAZO PHARMACY LLC
Other - Org Name:ELEVATE RX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STUART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-651-5246
Mailing Address - Street 1:1100 FM 1092 RD STE D
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1588
Mailing Address - Country:US
Mailing Address - Phone:281-651-5246
Mailing Address - Fax:
Practice Address - Street 1:1100 FM 1092 RD STE D
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-1588
Practice Address - Country:US
Practice Address - Phone:281-651-5246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31919OtherSTATE LICENSE
TX149897Medicaid