MEDICARE: STEPHEN CADDICK PHARM. D.

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	1835P1200X	Pharmacotherapy Pharmacist	PS37548	FL

General Provider Information

NPI Number	:	1245439132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN CADDICK PHARM. D.

Provider Business Mailing Address
First Line	:	12617 RACE TRACK RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1331
Country	:	US
Telephone Number	:	813-925-8200
Fax Number	:	813-925-8933

Provider Business Practice Location Address
First Line	:	12617 RACE TRACK RD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1331
Country	:	US
Telephone Number	:	813-925-8200
Fax Number	:	813-925-8933

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

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	06/04/2009

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