MEDICARE: RANDOLPH BAEZ R.PH.

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	PS22346	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS22346	OTHER	FL	FLORIDA BOARD OF PHARMACY

General Provider Information

NPI Number	:	1164890620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDOLPH BAEZ R.PH.

Provider Business Mailing Address
First Line	:	6435 HAZELTINE NATIONAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-5158
Country	:	US
Telephone Number	:	855-274-1694
Fax Number	:	855-819-6922

Provider Business Practice Location Address
First Line	:	6435 HAZELTINE NATIONAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-5158
Country	:	US
Telephone Number	:	855-274-1694
Fax Number	:	855-819-6922

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

Provider Enumeration Date	:	09/14/2015
Last Update Date	:	09/14/2015

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