MEDICARE: RYAN BRANTLEY PHARMD

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	PS62936	FL

General Provider Information

NPI Number	:	1679240170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN BRANTLEY PHARMD

Provider Business Mailing Address
First Line	:	18296 69TH DR
Second Line	:
City	:	MC ALPIN
State	:	FL
Zip	:	32062-2700
Country	:	US
Telephone Number	:	904-903-0547
Fax Number	:

Provider Business Practice Location Address
First Line	:	18296 69TH DR
Second Line	:
City	:	MC ALPIN
State	:	FL
Zip	:	32062-2700
Country	:	US
Telephone Number	:	904-903-0547
Fax Number	:

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

Provider Enumeration Date	:	08/24/2021
Last Update Date	:	08/24/2021

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Directions to “ RYAN BRANTLEY PHARMD” Practice Location

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