MEDICARE: MISS BRANDI WEBBER-ETHERIDGE 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	0202207655	VA

General Provider Information

NPI Number	:	1255463360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BRANDI WEBBER-ETHERIDGE PHARM.D.

Provider Business Mailing Address
First Line	:	100 ISABELLA LN APT 101
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6734
Country	:	US
Telephone Number	:	919-225-2110
Fax Number	:

Provider Business Practice Location Address
First Line	:	4417 CORPORATION LN
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3162
Country	:	US
Telephone Number	:	757-552-8964
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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