Provider Demographics
NPI:1336352244
Name:BRANCAZIO, MATTHEW BRANDON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRANDON
Last Name:BRANCAZIO
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 1:3181 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-9046
Mailing Address - Country:US
Mailing Address - Phone:928-453-1974
Mailing Address - Fax:
Practice Address - Street 1:3181 LONGVIEW DR
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86406-9046
Practice Address - Country:US
Practice Address - Phone:928-453-1974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13389183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist