Healthcare Provider Details

I. General information

NPI: 1841163227
Provider Name (Legal Business Name): MADISON JANE BROTZE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF LAMONT AND VETERANS WAY
MOUNTAIN HOME TN
37684
US

IV. Provider business mailing address

3115 ROCKY TOP RD APT 3
JOHNSON CITY TN
37601-7219
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-1171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3771776
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: