DR. BRANDON MATTHEW WILDERMUTH (NPI# 1629522750) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629522750 |
| Entity Type | Individual |
| Full Name | DR. BRANDON MATTHEW WILDERMUTH |
| Credential | PHARMD |
| Practice Address |
10720 Sw Village Pkwy Port St Lucie FL 34987-2188 |
| Mailing Address |
2439 Treasure Isle Dr Apt 4 West Palm Beach FL 33410-1359 |
| Practice Telephone | 7722936153 |
| Mailing Telephone | 3862164030 |
| Enumeration Date | 2016-08-05 |
| Last Update Date | 2016-08-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 183500000X | Pharmacist | PS55262 | FL | Pharmacy Service Providers |
| Street Address |
10720 SW VILLAGE PKWY |
| City | PORT ST LUCIE |
| State | FL |
| Zip Code | 34987-2188 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447467352 | Holiday Cvs LLC | Durable Medical Equipment & Medical Supplies | 10720 Sw Village Pkwy, Port St Lucie, FL 34987-2188 | 2007-05-17 |
| 1790166619 | Susanne Marie Sopko | Pharmacist | 10720 Sw Village Pkwy, Port St Lucie, FL 34987-2188 | 2015-06-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093299604 | Karen Cecilia Wong Li James | Registered Nurse | 10024 Sw Glenbrook Drive, Port Saint Lucie, FL 34987 | 2018-09-19 |
| 1134646151 | B & T Diagnostics LLC | Clinical Medical Laboratory | 11350 Sw Village Pkwy Ste 323, Port Saint Lucie, FL 34987 | 2017-08-30 |
| 1538684048 | Transport With Care, LLC | Non-emergency Medical Transport (VAN) | 1850 Sw Our Ct, Port Saint Lucie, FL 34987 | 2017-08-04 |
| 1154859825 | True Path Diagnostics, LLC | Clinical Medical Laboratory | 11350 Sw Village Pkwy Ste 309, Port St Lucie, FL 34987 | 2017-05-25 |
| 1316326515 | Aleksey Alekseyenko | Family Medicine | Mhpg Primary Care @ Tradition Health Park II, 10080 Sw Innovation Way Suite 201, Port St Lucie, FL 34987 | 2015-05-21 |
| 1053658583 | Tameka Argo | Contractor | 7664 Germany Canal Road, Fort Pierce, FL 34987 | 2013-01-03 |
| 1780967976 | Mennette J Colon | Specialist/Technologist, Other | 1970 Sw Glendale St., Port Saint Lucie, FL 34987 | 2011-09-23 |
| 1366416257 | Cynthia A Dolan | Dermatology | 10080 Sw Innovation Way Ste 301, Port St Lucie, FL 34987 | 2006-02-15 |
| 1205829074 | Andres M Reyes | Internal Medicine | 10050 Nw Innovation Way, Suite 102, Port St Lucie, FL 34987 | 2005-08-26 |
| 1720498470 | Josue Limage | Family Medicine | 10080 Sw Innovation Way Ste 201, Port St Lucie, FL 34987 | 2014-05-03 |
| Find all providers in zip 34987 | ||||
| Taxonomy Code | 183500000X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| 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. |
| Notes: Source: Adapted from National Association of Boards of Pharmacy Model State Pharmacy Act, Article 1, Section 104. [1/1/2006: definition modified, source modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417404898 | Chad Jarvis | Pharmacist | 2241 Se Heathwood Cir, Port St Lucie, FL 34952-6927 | 2016-09-02 |
| 1063883528 | Eusra Rahat Shams | Pharmacist | 4175 Sw Macad St, Port St Lucie, FL 34953-3152 | 2015-10-09 |
| 1295136331 | Nadera Jacob | Pharmacist | 4438 Sw Babylon St, Port St Lucie, FL 34953-6527 | 2014-09-09 |
| 1174924575 | Kristen Conner | Pharmacist | 1551 Sw Apricot Rd, Port St Lucie, FL 34953-4335 | 2014-09-04 |
| 1750709804 | Rx Navigation LLC | Pharmacist | 2019 Sw Aaron Ln, Port St Lucie, FL 34953-2104 | 2014-04-04 |
| 1922440700 | Karen Petula Purkiss | Pharmacist | 2308 Sw Valnera St, Port St Lucie, FL 34953-2431 | 2013-07-23 |
| 1679810329 | John M Fitzgerald | Pharmacist | 5473 Ne St James Dr, Port St Lucie, FL 34983 | 2013-01-14 |
| 1346587391 | Michelle Elaine Lavere | Pharmacist | 4226 Sw Utterback St, Port St Lucie, FL 34953-6854 | 2013-01-10 |
| 1861775967 | Glenn J Fronczkowski | Pharmacist | 2738 Se Eagle Dr, Port St Lucie, FL 34984-8913 | 2011-09-25 |
| 1366724031 | Jimmy Kyiwin Kabir | Pharmacist | 826 Sw Lake Charles Cir, Port St Lucie, FL 34986-3418 | 2011-09-19 |
| Find all providers in PORT ST LUCIE | ||||
| City | PORT ST LUCIE |
| Zip Code | 34987 |
Please comment or provide details below to improve the information on DR. BRANDON MATTHEW WILDERMUTH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.