MEDICARE: DR. MARK BRENNAN R.PH

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	017631	NV
2	183500000X	Pharmacist	0011837	OR
3	183500000X	Pharmacist	64139	CA

General Provider Information

NPI Number	:	1609178458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK BRENNAN R.PH

Provider Business Mailing Address
First Line	:	PO BOX 11265
Second Line	:
City	:	ZEPHYR COVE
State	:	NV
Zip	:	89448-3265
Country	:	US
Telephone Number	:	775-338-4145
Fax Number	:	775-586-9019

Provider Business Practice Location Address
First Line	:	212 ELKS POINT RD
Second Line	:
City	:	ZEPHYR COVE
State	:	NV
Zip	:	89448-9800
Country	:	US
Telephone Number	:	775-338-4145
Fax Number	:	775-586-9019

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

Provider Enumeration Date	:	11/30/2010
Last Update Date	:	11/30/2010

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Directions to “ DR. MARK BRENNAN R.PH” Practice Location

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