Brandon Matthew Wildermuth, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

PS55262 Issued in FL

Practice address

10720 SW Village Pkwy
Port St Lucie, FL 34987-2188

Phone

(772) 293-6153

NPI assigned

Aug 5, 2016

Last updated

Aug 5, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470355200000",
    "number": "1629522750",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2439 TREASURE ISLE DR APT 4",
            "city": "WEST PALM BEACH",
            "state": "FL",
            "postal_code": "334101359",
            "telephone_number": "386-216-4030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10720 SW VILLAGE PKWY",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349872188",
            "telephone_number": "772-293-6153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDERMUTH",
        "first_name": "BRANDON",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-05",
        "last_updated": "2016-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS55262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shane Donald Whiteley, DC
• Wholistic Medicine Clin
• Wickshire Port St. Lucie
• Dennis Darnell Wideman II
• Alex Wilburn, LPTA
• Stacey Wilfork, RN
• Taylor Wilhelm, DPT
• William Salcedo DPM PA
• Aisha J Williams
• Ashley Annette Williams, RDN/LDN

• Pharmacist in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Pharmacist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.