MEDICARE: DR. NANCY C. BRAHM PHARM.D., MS

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	1835P1300X	Psychiatric Pharmacist	11054	OK

General Provider Information

NPI Number	:	1659378735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY C. BRAHM PHARM.D., MS

Provider Business Mailing Address
First Line	:	4502 E 41ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-2553
Country	:	US
Telephone Number	:	918-660-3579
Fax Number	:	918-660-3009

Provider Business Practice Location Address
First Line	:	4502 E 41ST ST
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-2553
Country	:	US
Telephone Number	:	918-660-3579
Fax Number	:	918-660-3009

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	07/08/2007

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