MEDICARE: BRENDON CLOUGH 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	1835P1200X	Pharmacotherapy Pharmacist	64664	TX

General Provider Information

NPI Number	:	1134734593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDON CLOUGH PHARMD

Provider Business Mailing Address
First Line	:	8275 WALNUT HILL LN APT 223
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4586
Country	:	US
Telephone Number	:	817-219-4926
Fax Number	:

Provider Business Practice Location Address
First Line	:	1929 PRESTON RD
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-5102
Country	:	US
Telephone Number	:	972-713-5500
Fax Number	:

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

Provider Enumeration Date	:	09/12/2020
Last Update Date	:	09/12/2020

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