Provider Demographics
NPI:1174175681
Name:BRILL, AVA R (PHARMD)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:R
Last Name:BRILL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:AVA
Other - Middle Name:RENEE
Other - Last Name:BRILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1888 NW 97TH TER
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5951
Mailing Address - Country:US
Mailing Address - Phone:954-675-2515
Mailing Address - Fax:561-683-6872
Practice Address - Street 1:6901 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-2511
Practice Address - Country:US
Practice Address - Phone:561-683-6966
Practice Address - Fax:561-683-6966
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist