MEDICARE: SOPHIE BRANSON

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	2010033599	MO

General Provider Information

NPI Number	:	1205554433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIE BRANSON

Provider Business Mailing Address
First Line	:	3740 W TRUMAN BLVD
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-0537
Country	:	US
Telephone Number	:	573-893-1044
Fax Number	:

Provider Business Practice Location Address
First Line	:	3740 W TRUMAN BLVD
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-0537
Country	:	US
Telephone Number	:	573-893-1044
Fax Number	:	573-893-1041

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

Provider Enumeration Date	:	08/15/2022
Last Update Date	:	08/15/2022

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Directions to “ SOPHIE BRANSON ” Practice Location

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