MEDICARE: BRANDON GLEN ELDRIDGE 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	2009020986	MO
2	183500000X	Pharmacist	051.294668	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124258058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON GLEN ELDRIDGE PHARM.D.

Provider Business Mailing Address
First Line	:	1504 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1304
Country	:	US
Telephone Number	:	314-535-3334
Fax Number	:	314-535-3337

Provider Business Practice Location Address
First Line	:	1504 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-1304
Country	:	US
Telephone Number	:	314-535-3334
Fax Number	:	314-535-3337

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

Provider Enumeration Date	:	07/27/2009
Last Update Date	:	09/01/2015

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