MEDICARE: MR. KEITH E BROOME R,PH, MBA

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	12756	MD

General Provider Information

NPI Number	:	1326049750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEITH E BROOME R,PH, MBA

Provider Business Mailing Address
First Line	:	4 RUTH ST
Second Line	:
City	:	LAVALE
State	:	MD
Zip	:	21502-7018
Country	:	US
Telephone Number	:	301-777-5019
Fax Number	:	301-724-5212

Provider Business Practice Location Address
First Line	:	64 GREENE ST
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-2933
Country	:	US
Telephone Number	:	301-724-1183
Fax Number	:	301-724-5212

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/08/2007

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