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NPI Code Detail

MEDICARE: KIMBERLY S BRANDT

MEDICARE:   KIMBERLY S BRANDT
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
1183700000XPharmacy TechnicianCPT-0005931OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CPT-0005931OTHERORPHARMACY TECHNICIAN

General Provider Information

NPI Number : 1245503820
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY S BRANDT
Provider Business Mailing Address
First Line : 2510 ADAMS AVE
Second Line :
City : LA GRANDE
State : OR
Zip : 97850-3467
Country : US
Telephone Number : 541-963-9515
Fax Number : 541-963-8907
Provider Business Practice Location Address
First Line : 2510 ADAMS AVE
Second Line :
City : LA GRANDE
State : OR
Zip : 97850-3467
Country : US
Telephone Number : 541-963-9515
Fax Number : 541-963-8907
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2012
Last Update Date : 02/13/2012

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Directions to “ KIMBERLY S BRANDT ” Practice Location

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