Active NPI
Jordan Lynn Brazeal, PHARM.D.
- Pharmacist
- Pine Bluff, AR
National Provider Identifier
1568730091
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PD11871
- Practice address
- 4010 S Mulberry St
Pine Bluff, AR 71603-7000 - Phone
- (870) 541-6044
- Fax
- (870) 541-7601
- NPI assigned
- Dec 12, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PD11871 | AR | Primary |
Addresses
Primary practice location
4010 S Mulberry St
Pine Bluff, AR 71603-7000
Mailing address
4010 S Mulberry St
Pine Bluff, AR 71603-7000
Phone (870) 541-6044
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PD11871 | AR | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389916800000",
"number": "1568730091",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4010 S MULBERRY ST",
"city": "PINE BLUFF",
"state": "AR",
"postal_code": "716037000",
"telephone_number": "870-541-6044",
"fax_number": "870-541-7601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4010 S MULBERRY ST",
"city": "PINE BLUFF",
"state": "AR",
"postal_code": "716037000",
"telephone_number": "870-541-6044",
"fax_number": "870-541-7601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAZEAL",
"first_name": "JORDAN",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "PHARM.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-12-12",
"last_updated": "2014-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AR",
"license": "PD11871",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pine Bluff, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.