MEDICARE: KENNETH FREDRICK BROBECK PHARMACIST

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	RP028382L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RP028382L	OTHER	PA	PHARMACY LISCENSE

General Provider Information

NPI Number	:	1346568458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH FREDRICK BROBECK PHARMACIST

Provider Business Mailing Address
First Line	:	8901 STATE ROUTE 30
Second Line	:
City	:	IRWIN
State	:	PA
Zip	:	15642-2704
Country	:	US
Telephone Number	:	412-601-0272
Fax Number	:

Provider Business Practice Location Address
First Line	:	8901 STATE ROUTE 30
Second Line	:
City	:	NORTH HUNTINGDON
State	:	PA
Zip	:	15642-2704
Country	:	US
Telephone Number	:	724-864-7481
Fax Number	:

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

Provider Enumeration Date	:	05/13/2010
Last Update Date	:	10/29/2021

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