MEDICARE: DR. JUSTIN M BROCK 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	S016703	AZ
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	S016703	AZ
3	1835P1200X	Pharmacotherapy Pharmacist	S016703	AZ

General Provider Information

NPI Number	:	1659527513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN M BROCK PHARM D

Provider Business Mailing Address
First Line	:	1845 W ORANGE GROVE RD STE 115
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1146
Country	:	US
Telephone Number	:	520-670-0777
Fax Number	:	520-620-9738

Provider Business Practice Location Address
First Line	:	1845 W ORANGE GROVE RD STE 115
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1146
Country	:	US
Telephone Number	:	520-670-0777
Fax Number	:	520-620-9738

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

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	09/12/2022

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