MEDICARE: LORAINE BROGAN RPH

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	PH 00015486	WA

General Provider Information

NPI Number	:	1942613823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORAINE BROGAN RPH

Provider Business Mailing Address
First Line	:	16222 BOTHELL EVERETT HWY
Second Line	:
City	:	MILL CREEK
State	:	WA
Zip	:	98012-1520
Country	:	US
Telephone Number	:	425-741-8649
Fax Number	:	425-741-3741

Provider Business Practice Location Address
First Line	:	16222 BOTHELL EVERETT HWY
Second Line	:
City	:	MILL CREEK
State	:	WA
Zip	:	98012-1520
Country	:	US
Telephone Number	:	425-741-8649
Fax Number	:	425-741-3741

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

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	06/09/2014

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