MEDICARE: DR. BRANDON HAAS 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	26024778A	IN
2	183500000X	Pharmacist	03331294	OH

General Provider Information

NPI Number	:	1558641449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANDON HAAS PHARM. D.

Provider Business Mailing Address
First Line	:	101 E PIKE ST
Second Line	:	SUITE B, PO BOX 882
City	:	JACKSON CENTER
State	:	OH
Zip	:	45334-6000
Country	:	US
Telephone Number	:	937-596-8100
Fax Number	:	937-596-8108

Provider Business Practice Location Address
First Line	:	101 E PIKE ST
Second Line	:	SUITE B
City	:	JACKSON CENTER
State	:	OH
Zip	:	45334-6000
Country	:	US
Telephone Number	:	937-596-8100
Fax Number	:	937-596-8108

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

Provider Enumeration Date	:	08/23/2011
Last Update Date	:	03/16/2014

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