MEDICARE: HARRIETH N ALADIUME

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
1	3336C0003X	Community/Retail Pharmacy	PH24008	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2121191	OTHER		PK

General Provider Information

NPI Number	:	1063642197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARRIETH N ALADIUME

Provider Business Mailing Address
First Line	:	2039 E EDGEWOOD DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-3601
Country	:	US
Telephone Number	:	863-937-1050
Fax Number	:	863-937-1055

Provider Business Practice Location Address
First Line	:	2039 E EDGEWOOD DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-3601
Country	:	US
Telephone Number	:	863-937-1050
Fax Number	:	863-937-1055

Authorized Official
Title or Position	:	PHARMACIST/MANAGER
Name	:	ABIY TEKLE
Credential	:	PHARMD
Telephone Number	:	339-224-0842

Provider Enumeration Date	:	07/23/2009
Last Update Date	:	01/20/2015

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Directions to “HARRIETH N ALADIUME ” Practice Location

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