MEDICARE: JULIE BROCKWAY

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	5302038636	MI

General Provider Information

NPI Number	:	1720363799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE BROCKWAY

Provider Business Mailing Address
First Line	:	620 MAY ST
Second Line	:	APT 9
City	:	LANSING
State	:	MI
Zip	:	48906-5296
Country	:	US
Telephone Number	:	586-219-2245
Fax Number	:

Provider Business Practice Location Address
First Line	:	812 E SAGINAW HWY
Second Line	:
City	:	GRAND LEDGE
State	:	MI
Zip	:	48837-8410
Country	:	US
Telephone Number	:	517-627-1240
Fax Number	:

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

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	10/20/2011

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Directions to “ JULIE BROCKWAY ” Practice Location

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