MEDICARE: AMANDA MARIE DEBRUIN PHARM.D., BCPS, CGP

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	1835P1200X	Pharmacotherapy Pharmacist	PS38774	FL

General Provider Information

NPI Number	:	1134114440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA MARIE DEBRUIN PHARM.D., BCPS, CGP

Provider Business Mailing Address
First Line	:	12901 BRUCE B DOWNS BLVD
Second Line	:	MDC 13
City	:	TAMPA
State	:	FL
Zip	:	33612-4742
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12901 BRUCE B DOWNS BLVD
Second Line	:	MDC 13
City	:	TAMPA
State	:	FL
Zip	:	33612-4742
Country	:	US
Telephone Number	:	813-974-2445
Fax Number	:

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

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	06/28/2010

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