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NPI Code Detail

MEDICARE: MRS. CARMEN E. CARDONA RPH

MEDICARE: MRS. CARMEN E. CARDONA RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist1889PR

General Provider Information

NPI Number : 1003803289
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CARMEN E. CARDONA RPH
Provider Business Mailing Address
First Line : 392 SW ACE LN
Second Line :
City : LAKE CITY
State : FL
Zip : 32025-2907
Country : US
Telephone Number : 386-755-3582
Fax Number :
Provider Business Practice Location Address
First Line : 619 S MARION AVE
Second Line :
City : LAKE CITY
State : FL
Zip : 32025-5808
Country : US
Telephone Number : 386-755-3016
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2005
Last Update Date : 07/08/2007

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