MEDICARE: NIKKI BROWN-SHORT 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	14298	AL

General Provider Information

NPI Number	:	1437445806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKKI BROWN-SHORT PHARMD

Provider Business Mailing Address
First Line	:	3150 BEL AIR MALL
Second Line	:	T-0797
City	:	MOBILE
State	:	AL
Zip	:	36606-3206
Country	:	US
Telephone Number	:	251-471-9768
Fax Number	:	251-471-9776

Provider Business Practice Location Address
First Line	:	3150 BEL AIR MALL
Second Line	:	T-0797
City	:	MOBILE
State	:	AL
Zip	:	36606-3206
Country	:	US
Telephone Number	:	251-471-9768
Fax Number	:	251-471-9776

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

Provider Enumeration Date	:	06/23/2011
Last Update Date	:	06/23/2011

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