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DR. KELLY E. BRODETSKY PHARMD NPI 1659446540


NPI Information

NPI: 1659446540
Provider Name: DR. KELLY E. BRODETSKY, PHARMD
Classification: Pharmacist - 183500000X
Entity Type: Individual
Address:
10501 LANSING STREET
#904
MENDOCINO, CA
ZIP 95460
Phone: (707) 937-4800
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DR. Kelly E. Brodetsky, PHARMD is a pharmacist in Mendocino, CA. The provider is an individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care. DR. Kelly E. Brodetsky, PHARMD NPI is 1659446540. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

10501 LANSING STREET
#904
MENDOCINO, CA
ZIP 95460-904
Phone: (707) 937-4800
Fax: (707) 937-5800

The enumeration date for this NPI number is 11/24/2006 and was last updated on 3/7/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1183500000XPharmacistPHY45989CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1PHY45989OTHERCALIFORNIASTATE LICENSE NUMBER
2412046786OTHERCALIFORNIAFEDERAL TAX ID
30582292OTHERCALIFORNIANCPDP NUMBER
4PHA459890MEDICAIDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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