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NPI Code Detail

MEDICARE: MR. BRIAN BROUILLETTE PHARMD

MEDICARE: MR. BRIAN BROUILLETTE 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
1183500000XPharmacist0202211203VA

General Provider Information

NPI Number : 1649536319
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN BROUILLETTE PHARMD
Provider Business Mailing Address
First Line : 2500 N HARRISON ST
Second Line :
City : ARLINGTON
State : VA
Zip : 22207-1600
Country : US
Telephone Number : 703-538-6911
Fax Number :
Provider Business Practice Location Address
First Line : 2500 N HARRISON ST
Second Line :
City : ARLINGTON
State : VA
Zip : 22207-1600
Country : US
Telephone Number : 703-538-6911
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2012
Last Update Date : 04/07/2012

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