MEDICARE: AARON C BRENTZEL BS PHARM

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	14522	NC

General Provider Information

NPI Number	:	1972895183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON C BRENTZEL BS PHARM

Provider Business Mailing Address
First Line	:	9720 REA RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6663
Country	:	US
Telephone Number	:	704-752-1164
Fax Number	:	704-752-1651

Provider Business Practice Location Address
First Line	:	9720 REA RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-6663
Country	:	US
Telephone Number	:	704-752-1164
Fax Number	:	704-752-1651

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

Provider Enumeration Date	:	05/05/2011
Last Update Date	:	05/05/2011

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