MEDICARE: DR. NICHOLAS D. MAROULIS

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	183500000X	Pharmacist	PS 28571	FL

General Provider Information

NPI Number	:	1073865549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS D. MAROULIS

Provider Business Mailing Address
First Line	:	376 NORTHLAKE BLVD
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5261
Country	:	US
Telephone Number	:	407-830-8820
Fax Number	:	800-269-5473

Provider Business Practice Location Address
First Line	:	376 NORTHLAKE BLVD
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5261
Country	:	US
Telephone Number	:	407-830-8820
Fax Number	:	800-269-5473

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	10/09/2012

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