MEDICARE: MR. PATRICK MARK SWEENEY RPH

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	PS0023810	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS0023810	OTHER	FL	PHARMACIST LICENSE NUMBER

General Provider Information

NPI Number	:	1225120611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PATRICK MARK SWEENEY RPH

Provider Business Mailing Address
First Line	:	6514 BLACKFIN WAY
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-3024
Country	:	US
Telephone Number	:	813-641-0411
Fax Number	:	813-641-0411

Provider Business Practice Location Address
First Line	:	6188 N US HIGHWAY 41
Second Line	:
City	:	APOLLO BEACH
State	:	FL
Zip	:	33572-1806
Country	:	US
Telephone Number	:	813-649-1304
Fax Number	:	813-649-1305

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/09/2007

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