Dr Kelly E Brodetsky, PHARMD | |
10501 Lansing Street, #904, Mendocino, CA 95460-0904 | |
(707) 937-4800 | |
(707) 937-5800 |
Full Name | Dr Kelly E Brodetsky |
---|---|
Gender | Female |
Speciality | Pharmacist |
Location | 10501 Lansing Street, Mendocino, California |
Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1659446540 | NPI | - | NPPES |
PHY45989 | Other | CA | STATE LICENSE NUMBER |
412046786 | Other | CA | FEDERAL TAX ID |
0582292 | Other | CA | NCPDP NUMBER |
PHA459890 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
183500000X | Pharmacist | PHY45989 (California) | Primary |
Mailing Address | Practice Location Address |
---|---|
Dr Kelly E Brodetsky, PHARMD Po Box 904, Mendocino, CA 95460-0904 Ph: (707) 937-4800 | Dr Kelly E Brodetsky, PHARMD 10501 Lansing Street, #904, Mendocino, CA 95460-0904 Ph: (707) 937-4800 |
Mr. Jerold Kent Karabensh, RPH Pharmacist Medicare: Not Enrolled in Medicare Practice Location: 45275 Mar Vista Dr, Mendocino, CA 95460 Phone: 707-937-3087 |