Kelly E. Brodetsky, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

PHY45989 Issued in CA

Practice address

10501 Lansing Street
#904
Mendocino, CA 95460-0904

Phone

(707) 937-4800

Fax

(707) 937-5800

NPI assigned

Nov 24, 2006

Sex

Female

Sole proprietor

Yes

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, last updated by the provider on Mar 7, 2023.

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1659446540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 904",
            "city": "MENDOCINO",
            "state": "CA",
            "postal_code": "954600904",
            "telephone_number": "707-937-4800",
            "fax_number": "707-937-5800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10501 LANSING STREET",
            "address_2": "#904",
            "city": "MENDOCINO",
            "state": "CA",
            "postal_code": "954600904",
            "telephone_number": "707-937-4800",
            "fax_number": "707-937-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODETSKY",
        "first_name": "KELLY",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-24",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CA",
            "license": "PHY45989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "PHY45989",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID",
            "identifier": "412046786",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP NUMBER",
            "identifier": "0582292",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA459890",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Judith Ann Bayer, LAC AC
• Jeffrey Alan Berenson, MD
• Kathleen Heather Biggie, CD
• Walter A Boyle III, MD
• Saelon Britton, P.T.
• Angela Emily Burdick
• Angela Rose Carpenter, DOULA
• Karen Ann Chamberlain, L.AC.
• Arthur Robert Ciancutti, MD
• Amy Davis, R.D.M.S. 81478

• All providers in Mendocino, CA
• Pharmacist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.