MEDICARE: SARAH JANE BRIESKE

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	017749	GA

General Provider Information

NPI Number	:	1831798479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH JANE BRIESKE

Provider Business Mailing Address
First Line	:	2700 BRASELTON HWY
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-3262
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 BRASELTON HWY
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-3262
Country	:	US
Telephone Number	:	770-614-1022
Fax Number	:

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

Provider Enumeration Date	:	10/24/2020
Last Update Date	:	10/24/2020

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Directions to “ SARAH JANE BRIESKE ” Practice Location

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