MEDICARE: DR. CEDRIC BRANDON OWENS 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	26022924A	IN
2	183500000X	Pharmacist	014182	KY
3	183500000X	Pharmacist	PS43845	FL

General Provider Information

NPI Number	:	1811143472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CEDRIC BRANDON OWENS PHARMD

Provider Business Mailing Address
First Line	:	934 SPRING ST
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3639
Country	:	US
Telephone Number	:	812-283-1389
Fax Number	:

Provider Business Practice Location Address
First Line	:	934 SPRING ST
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3639
Country	:	US
Telephone Number	:	812-283-1389
Fax Number	:

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

Provider Enumeration Date	:	08/14/2008
Last Update Date	:	08/14/2008

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