MEDICARE: DYLAN TURNBACH

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	PS65941	FL

General Provider Information

NPI Number	:	1225718539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYLAN TURNBACH

Provider Business Mailing Address
First Line	:	169 PENDARVIS RD
Second Line	:
City	:	LAKE PLACID
State	:	FL
Zip	:	33852-6817
Country	:	US
Telephone Number	:	954-604-1888
Fax Number	:

Provider Business Practice Location Address
First Line	:	586 US HIGHWAY 27 N
Second Line	:
City	:	LAKE PLACID
State	:	FL
Zip	:	33852-9508
Country	:	US
Telephone Number	:	954-604-1888
Fax Number	:

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

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	07/20/2023

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Directions to “ DYLAN TURNBACH ” Practice Location

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