Provider Demographics
NPI:1255614038
Name:BRISMA PHARMACY PLLC
Entity type:Organization
Organization Name:BRISMA PHARMACY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IBORO
Authorized Official - Middle Name:
Authorized Official - Last Name:AKPAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:480-577-8726
Mailing Address - Street 1:590 N ALMA SCHOOL RD
Mailing Address - Street 2:STE 3
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4361
Mailing Address - Country:US
Mailing Address - Phone:480-719-8798
Mailing Address - Fax:480-719-8795
Practice Address - Street 1:590 N ALMA SCHOOL RD
Practice Address - Street 2:STE 3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4361
Practice Address - Country:US
Practice Address - Phone:480-719-8798
Practice Address - Fax:480-719-8795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AZY0054213336L0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132211OtherPK
AZ651175Medicaid
0357283OtherNCPDP PROVIDER IDENTIFICATION NUMBER