MEDICARE: BRANDON LUSAN RPHT

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	183700000X	Pharmacy Technician	RPT54865	FL

General Provider Information

NPI Number	:	1114321254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON LUSAN RPHT

Provider Business Mailing Address
First Line	:	10016 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6137
Country	:	US
Telephone Number	:	954-435-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	10016 PINES BLVD
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6137
Country	:	US
Telephone Number	:	954-435-7200
Fax Number	:

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

Provider Enumeration Date	:	10/17/2014
Last Update Date	:	10/17/2014

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