MEDICARE: DERRICK LAMBERTON

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	PS39341	FL

General Provider Information

NPI Number	:	1386930899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERRICK LAMBERTON

Provider Business Mailing Address
First Line	:	4450 PARK ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-4020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4450 PARK ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33709-4020
Country	:	US
Telephone Number	:	727-541-3930
Fax Number	:

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

Provider Enumeration Date	:	06/22/2011
Last Update Date	:	06/22/2011

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Directions to “ DERRICK LAMBERTON ” Practice Location

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