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NPI Code Detail

MEDICARE: BRONCHO DOSE LTD

MEDICARE: BRONCHO DOSE LTD
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
1332B00000XDurable Medical Equipment & Medical Supplies1732CT

General Provider Information

NPI Number : 1750363610
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRONCHO DOSE LTD
Provider Business Mailing Address
First Line : PO BOX 520
Second Line :
City : SOUTHPORT
State : CT
Zip : 06890-0520
Country : US
Telephone Number : 203-375-8000
Fax Number : 800-784-5430
Provider Business Practice Location Address
First Line : 55 ONTARIO ST
Second Line :
City : STRATFORD
State : CT
Zip : 06615-7135
Country : US
Telephone Number : 203-375-8000
Fax Number : 800-784-5430
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : DR. MICHAEL WILLIAM LICAMELE
Credential : PHARM. D.
Telephone Number : 203-375-8000
Provider Enumeration Date : 11/16/2005
Last Update Date : 03/07/2023

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Directions to “BRONCHO DOSE LTD ” Practice Location

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