MEDICARE: BRIANNA LINN GUTIERREZ 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
1	183500000X	Pharmacist	67009	TX

General Provider Information

NPI Number	:	1679183081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA LINN GUTIERREZ PHARMD

Provider Business Mailing Address
First Line	:	6520 FRATT RD STE 110
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-4486
Country	:	US
Telephone Number	:	210-646-0295
Fax Number	:

Provider Business Practice Location Address
First Line	:	6520 FRATT RD STE 110
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218-4486
Country	:	US
Telephone Number	:	210-646-0295
Fax Number	:

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

Provider Enumeration Date	:	08/01/2020
Last Update Date	:	08/03/2020

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