MEDICARE: MR. BRIAN JOSEPH PETRUCCI 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	PS54305	FL
2	1835P1200X	Pharmacotherapy Pharmacist	41796	TX

General Provider Information

NPI Number	:	1215279120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN JOSEPH PETRUCCI RPH.

Provider Business Mailing Address
First Line	:	9375 EMERALD COAST PKWY W STE 6
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-7275
Country	:	US
Telephone Number	:	850-424-7438
Fax Number	:	850-764-5382

Provider Business Practice Location Address
First Line	:	9375 EMERALD COAST PKWY W STE 27B
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-7222
Country	:	US
Telephone Number	:	850-424-7438
Fax Number	:	850-396-0587

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

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	12/19/2025

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