MEDICARE: PATRICIA HOLBROOK 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	13584	MD

General Provider Information

NPI Number	:	1770689937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA HOLBROOK R.PH.

Provider Business Mailing Address
First Line	:	1415 EVERGREEN RD
Second Line	:
City	:	SEVERN
State	:	MD
Zip	:	21144-2613
Country	:	US
Telephone Number	:	410-551-2689
Fax Number	:

Provider Business Practice Location Address
First Line	:	1415 EVERGREEN RD
Second Line	:
City	:	SEVERN
State	:	MD
Zip	:	21144-2613
Country	:	US
Telephone Number	:	410-551-2689
Fax Number	:

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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Directions to “ PATRICIA HOLBROOK R.PH.” Practice Location

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