MEDICARE: BRANDIE NICHOLE GROLEMUND RPHT

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	183700000X	Pharmacy Technician	RPT10432	FL

General Provider Information

NPI Number	:	1194013011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDIE NICHOLE GROLEMUND RPHT

Provider Business Mailing Address
First Line	:	4651 CORTEZ RD W
Second Line	:	PHARMACY
City	:	BRADENTON
State	:	FL
Zip	:	34210-3146
Country	:	US
Telephone Number	:	941-792-7325
Fax Number	:	941-792-7506

Provider Business Practice Location Address
First Line	:	4651 CORTEZ RD W
Second Line	:	PHARMACY
City	:	BRADENTON
State	:	FL
Zip	:	34210-3146
Country	:	US
Telephone Number	:	941-792-7325
Fax Number	:	941-792-7506

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

Provider Enumeration Date	:	07/12/2011
Last Update Date	:	07/12/2011

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