MEDICARE: JEFFERY LLOYD BROXSON RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS0030572	FL

General Provider Information

NPI Number	:	1013114578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY LLOYD BROXSON RPH

Provider Business Mailing Address
First Line	:	3275 GARDEN ST
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-3004
Country	:	US
Telephone Number	:	321-267-1233
Fax Number	:

Provider Business Practice Location Address
First Line	:	3275 GARDEN ST
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32796-3004
Country	:	US
Telephone Number	:	321-267-1233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	02/12/2013

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