MEDICARE: MS. BRENDA GAIL SMITH B.S.

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	PS0024168	FL

General Provider Information

NPI Number	:	1699099002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRENDA GAIL SMITH B.S.

Provider Business Mailing Address
First Line	:	1525 SADLER RD
Second Line	:	1525 SADLER RD.
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4467
Country	:	US
Telephone Number	:	904-463-1670
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 SADLER RD
Second Line	:	1525 SADLER RD.
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4467
Country	:	US
Telephone Number	:	904-463-1670
Fax Number	:

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

Provider Enumeration Date	:	03/15/2010
Last Update Date	:	03/15/2010

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