MEDICARE: STEPHANIE PERALES-BROEKEMEIER 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	40092	TX

General Provider Information

NPI Number	:	1184952384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE PERALES-BROEKEMEIER PHARM D

Provider Business Mailing Address
First Line	:	6103 FARINON DR
Second Line	:	BUILDING VI, SUITE 600
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3442
Country	:	US
Telephone Number	:	210-694-9217
Fax Number	:	210-694-9547

Provider Business Practice Location Address
First Line	:	6103 FARINON DR
Second Line	:	BUILDING VI, SUITE 600
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-3442
Country	:	US
Telephone Number	:	210-694-9217
Fax Number	:	210-694-9547

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

Provider Enumeration Date	:	11/27/2009
Last Update Date	:	11/27/2009

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