MEDICARE: SANDRA PATRICIA RESTREPO

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	33268	FL

General Provider Information

NPI Number	:	1134831936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA PATRICIA RESTREPO

Provider Business Mailing Address
First Line	:	400 ANSIN BLVD
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-3104
Country	:	US
Telephone Number	:	305-919-7399
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 ANSIN BLVD
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-3104
Country	:	US
Telephone Number	:	305-919-7399
Fax Number	:

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

Provider Enumeration Date	:	12/23/2022
Last Update Date	:	12/23/2022

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Directions to “ SANDRA PATRICIA RESTREPO ” Practice Location

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