MEDICARE: MR. WILLIAM BRANDON AMMONS RPH

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	37890	TX

General Provider Information

NPI Number	:	1649515263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM BRANDON AMMONS RPH

Provider Business Mailing Address
First Line	:	2751 N COUNTY RD W
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79764-1665
Country	:	US
Telephone Number	:	432-333-1591
Fax Number	:	432-335-0839

Provider Business Practice Location Address
First Line	:	2751 N COUNTY RD W
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79764-1665
Country	:	US
Telephone Number	:	432-333-1591
Fax Number	:	432-335-0839

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

Provider Enumeration Date	:	12/07/2012
Last Update Date	:	12/07/2012

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