MEDICARE: BRANDON VAN AMBER

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	20255	WI
2	183500000X	Pharmacist	122933	MN

General Provider Information

NPI Number	:	1255160313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON VAN AMBER

Provider Business Mailing Address
First Line	:	11739 W BRADLEY RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-2531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11739 W BRADLEY RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-2531
Country	:	US
Telephone Number	:	800-723-4396
Fax Number	:

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

Provider Enumeration Date	:	07/29/2024
Last Update Date	:	07/29/2024

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Directions to “ BRANDON VAN AMBER ” Practice Location

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