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NPI Code Detail

MEDICARE: MACKENZIE BRODE PHARMD

MEDICARE: MACKENZIE BRODE 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
1183500000XPharmacist21649MD

General Provider Information

NPI Number : 1730592783
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE BRODE PHARMD
Provider Business Mailing Address
First Line : 8501 FORT SMALLWOOD RD
Second Line :
City : PASADENA
State : MD
Zip : 21122-2607
Country : US
Telephone Number : 410-437-1149
Fax Number : 410-439-3043
Provider Business Practice Location Address
First Line : 8501 FORT SMALLWOOD RD
Second Line :
City : PASADENA
State : MD
Zip : 21122-2607
Country : US
Telephone Number : 410-437-1149
Fax Number : 410-439-3043
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2014
Last Update Date : 06/07/2014

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Directions to “ MACKENZIE BRODE PHARMD” Practice Location

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