MEDICARE: DAVID ROBERT BRETZKE PHARM.D.

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	35292	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35292	OTHER	TX	PHARMACY LICENCE NUMBER

General Provider Information

NPI Number	:	1326125006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ROBERT BRETZKE PHARM.D.

Provider Business Mailing Address
First Line	:	186 LACELEAF LN
Second Line	:
City	:	CIBOLO
State	:	TX
Zip	:	78108-3153
Country	:	US
Telephone Number	:	210-945-0715
Fax Number	:

Provider Business Practice Location Address
First Line	:	186 LACELEAF LN
Second Line	:
City	:	CIBOLO
State	:	TX
Zip	:	78108-3153
Country	:	US
Telephone Number	:	210-945-0715
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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