MEDICARE: DR. BRANDON BORDERS PHARM.D.

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	013670	KY

General Provider Information

NPI Number	:	1104108703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON BORDERS PHARM.D.

Provider Business Mailing Address
First Line	:	6620 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-3045
Country	:	US
Telephone Number	:	502-231-1310
Fax Number	:

Provider Business Practice Location Address
First Line	:	6620 BARDSTOWN RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-3045
Country	:	US
Telephone Number	:	502-231-1310
Fax Number	:

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

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	09/09/2011

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