Provider Demographics
NPI:1730476375
Name:BRODMAN, MONIKA LYNN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MONIKA
Middle Name:LYNN
Last Name:BRODMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MISS
Other - First Name:MONIKA
Other - Middle Name:LYNN
Other - Last Name:COLETTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:566 ANDOVER CIR
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-4251
Mailing Address - Country:US
Mailing Address - Phone:937-367-5860
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # DD-30
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1002
Practice Address - Country:US
Practice Address - Phone:216-445-0873
Practice Address - Fax:216-636-5272
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03129338183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist