MEDICARE: MR. PRAMOD THOMAS B.PHARM, B.SC.

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	PS39208	FL

General Provider Information

NPI Number	:	1164702643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PRAMOD THOMAS B.PHARM, B.SC.

Provider Business Mailing Address
First Line	:	2425 US HIGHWAY 92 E
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-2649
Country	:	US
Telephone Number	:	863-666-6670
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 US HIGHWAY 92 E
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-2649
Country	:	US
Telephone Number	:	863-666-6670
Fax Number	:

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

Provider Enumeration Date	:	08/28/2011
Last Update Date	:	08/28/2011

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