Provider Demographics
NPI:1760124788
Name:BRAVA NC LLC
Entity Type:Organization
Organization Name:BRAVA NC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:919-586-8287
Mailing Address - Street 1:3800 GATEWAY CENTRE BLVD STE 308A
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6220
Mailing Address - Country:US
Mailing Address - Phone:919-586-8287
Mailing Address - Fax:
Practice Address - Street 1:3800 GATEWAY CENTRE BLVD STE 308A
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-6220
Practice Address - Country:US
Practice Address - Phone:919-586-8287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy