Provider Demographics
NPI:1992081038
Name:BROOME, VICTORIA MARIE (PHARM D)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:MARIE
Last Name:BROOME
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:MARIE
Other - Last Name:REINHARTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARM D
Mailing Address - Street 1:6150 14TH ST W
Mailing Address - Street 2:T-0817
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-4622
Mailing Address - Country:US
Mailing Address - Phone:941-756-3582
Mailing Address - Fax:
Practice Address - Street 1:6150 14TH ST W
Practice Address - Street 2:T-0817
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4622
Practice Address - Country:US
Practice Address - Phone:941-756-3582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48143183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist