MEDICARE: DR. MATTHEW BRANDON BRANCAZIO PHARMD

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	13389	AZ

General Provider Information

NPI Number	:	1336352244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW BRANDON BRANCAZIO PHARMD

Provider Business Mailing Address
First Line	:	3181 LONGVIEW DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-9046
Country	:	US
Telephone Number	:	928-453-1974
Fax Number	:

Provider Business Practice Location Address
First Line	:	3181 LONGVIEW DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-9046
Country	:	US
Telephone Number	:	928-453-1974
Fax Number	:

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/08/2007

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