MEDICARE: DR. HARLEY JOHN BROTHERTON II PHARMD.

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	16649	NV
2	183500000X	Pharmacist	5888	MT
3	183500000X	Pharmacist	41135	WA

General Provider Information

NPI Number	:	1134115678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARLEY JOHN BROTHERTON II PHARMD.

Provider Business Mailing Address
First Line	:	145 BUFFALO STAGE
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-2780
Country	:	US
Telephone Number	:	406-257-3258
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 SUNNYVIEW LN
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3129
Country	:	US
Telephone Number	:	406-752-1761
Fax Number	:

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	03/02/2008

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