MEDICARE: DR. MATTHEW DONOVAN BROOME 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	35590	SC

General Provider Information

NPI Number	:	1700292919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW DONOVAN BROOME PHARMD

Provider Business Mailing Address
First Line	:	1601 SANDIFER BLVD
Second Line	:
City	:	SENECA
State	:	SC
Zip	:	29678-0905
Country	:	US
Telephone Number	:	864-885-0889
Fax Number	:	803-482-6533

Provider Business Practice Location Address
First Line	:	6330 RICHBURG RD
Second Line	:
City	:	GREAT FALLS
State	:	SC
Zip	:	29055-8916
Country	:	US
Telephone Number	:	803-374-2480
Fax Number	:	803-482-6533

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

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	09/12/2014

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