MEDICARE: DR. DALIA W BANOOB PHARMD

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 33645	FL
2	183500000X	Pharmacist	23352	MA
3	183500000X	Pharmacist	PU 5624	FL

General Provider Information

NPI Number	:	1134302615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALIA W BANOOB PHARMD

Provider Business Mailing Address
First Line	:	6285 E FOWLER AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-3304
Country	:	US
Telephone Number	:	813-983-1500
Fax Number	:	813-983-1501

Provider Business Practice Location Address
First Line	:	6285 E FOWLER AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-3304
Country	:	US
Telephone Number	:	813-983-1500
Fax Number	:	813-983-1501

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

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	12/07/2007

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