MEDICARE: AMY JENNIFER BRANDS 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	12546	AZ
2	183500000X	Pharmacist	17588	NV
3	183500000X	Pharmacist	76647361701	UT

General Provider Information

NPI Number	:	1669763959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY JENNIFER BRANDS RPH

Provider Business Mailing Address
First Line	:	11248 BEDFORD HILLS AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-3002
Country	:	US
Telephone Number	:	916-501-2398
Fax Number	:

Provider Business Practice Location Address
First Line	:	278 S DECATUR BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2936
Country	:	US
Telephone Number	:	916-501-2398
Fax Number	:

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

Provider Enumeration Date	:	04/21/2011
Last Update Date	:	04/21/2011

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