MEDICARE: DR. ERIN C BROTHERTON PHARM.D., CGP

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	16671	NV
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	3983	MT

General Provider Information

NPI Number	:	1497741938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIN C BROTHERTON PHARM.D., CGP

Provider Business Mailing Address
First Line	:	145 BUFFALO STAGE
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-2780
Country	:	US
Telephone Number	:	406-257-3258
Fax Number	:

Provider Business Practice Location Address
First Line	:	2716 N TENAYA WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0424
Country	:	US
Telephone Number	:	702-467-8811
Fax Number	:

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	05/08/2008

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