MEDICARE: BRANDON P SIS MBA, 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	RPH-0011746	OR
2	183500000X	Pharmacist	119875	MN

General Provider Information

NPI Number	:	1992945273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON P SIS MBA, PHARM.D

Provider Business Mailing Address
First Line	:	50 SHERBURNE AVE
Second Line	:	SUITE 112
City	:	SAINT PAUL
State	:	MN
Zip	:	55155-1402
Country	:	US
Telephone Number	:	651-201-3106
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 SHERBURNE AVE
Second Line	:	SUITE 112
City	:	SAINT PAUL
State	:	MN
Zip	:	55155-1402
Country	:	US
Telephone Number	:	651-201-3106
Fax Number	:

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

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	03/18/2016

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