MEDICARE: BRANDYN MICHAEL FREITAS PHARMACIST

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	238998	MA
2	183500000X	Pharmacist	PH238998	MA

General Provider Information

NPI Number	:	1902401839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDYN MICHAEL FREITAS PHARMACIST

Provider Business Mailing Address
First Line	:	419 E FALMOUTH HWY
Second Line	:
City	:	EAST FALMOUTH
State	:	MA
Zip	:	02536-6166
Country	:	US
Telephone Number	:	508-540-8621
Fax Number	:	508-540-1517

Provider Business Practice Location Address
First Line	:	419 E FALMOUTH HWY
Second Line	:
City	:	EAST FALMOUTH
State	:	MA
Zip	:	02536-6166
Country	:	US
Telephone Number	:	508-540-8621
Fax Number	:	508-540-1517

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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