Healthcare Provider Details

I. General information

NPI: 1073082863
Provider Name (Legal Business Name): BRANDON RYAN HOFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HIGHWAY 6 W
IOWA CITY IA
52246-2209
US

IV. Provider business mailing address

7687 SILVER SANDS RD
KEYSTONE HEIGHTS FL
32656-8464
US

V. Phone/Fax

Practice location:
  • Phone: 352-222-1576
  • Fax:
Mailing address:
  • Phone: 352-222-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberRPT75741
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30061947
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: