Provider Demographics
NPI:1740658897
Name:BRAZEAL, THOMAS
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BRAZEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 N EL CIELO RD
Mailing Address - Street 2:C322
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6992
Mailing Address - Country:US
Mailing Address - Phone:760-969-6560
Mailing Address - Fax:
Practice Address - Street 1:255 N EL CIELO RD
Practice Address - Street 2:C322
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6992
Practice Address - Country:US
Practice Address - Phone:760-969-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-07
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73320183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist