Provider Demographics
NPI:1922608397
Name:BRACEWELL, ERIC RAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:RAY
Last Name:BRACEWELL
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 1:287 LONG WAY S
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31523-7913
Mailing Address - Country:US
Mailing Address - Phone:912-278-2238
Mailing Address - Fax:
Practice Address - Street 1:10100 CANAL XING
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-6705
Practice Address - Country:US
Practice Address - Phone:912-602-6809
Practice Address - Fax:912-602-6808
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist