MEDICARE: MRS. BROOKE DANIELLE MILLEMON PHARM D.

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	3080	WY

General Provider Information

NPI Number	:	1972626604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BROOKE DANIELLE MILLEMON PHARM D.

Provider Business Mailing Address
First Line	:	1312 VIRGINIA ST
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-6532
Country	:	US
Telephone Number	:	307-382-5882
Fax Number	:	307-382-0987

Provider Business Practice Location Address
First Line	:	400 2ND ST STE A-1
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-6260
Country	:	US
Telephone Number	:	307-382-3544
Fax Number	:	307-382-0987

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	07/08/2007

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