MEDICARE: MRS. BRENDA GAIL BREWER R.PH.

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	007568	KY

General Provider Information

NPI Number	:	1568752616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA GAIL BREWER R.PH.

Provider Business Mailing Address
First Line	:	125 N. MAIN STREET
Second Line	:
City	:	STANTON
State	:	KY
Zip	:	40380
Country	:	US
Telephone Number	:	606-663-2520
Fax Number	:	606-663-7662

Provider Business Practice Location Address
First Line	:	125 NORTH MAIN ST.
Second Line	:
City	:	STANTON
State	:	KY
Zip	:	40380-0278
Country	:	US
Telephone Number	:	606-663-2520
Fax Number	:	606-663-7662

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

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	04/11/2011

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