Individual
KAYLA BRASWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12921 ENTERPRISE WAY, BRIDGETON, MO 63044-1206
(314) 344-9201
Mailing address
2770 STONEBRIDGE CT, MARYVILLE, IL 62062-6452
(618) 499-0536
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2018028000
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2018028000
REGISTERED PHARMACIST LICENSE NUMBER
MO
Enumeration date
07/31/2018
Last updated
07/31/2018
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