MEDICARE: TRYSTAL LAMPKIN

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	PS35977	FL

General Provider Information

NPI Number	:	1407194491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRYSTAL LAMPKIN

Provider Business Mailing Address
First Line	:	PO BOX 1183
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34954-1183
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 SE PORT ST LUCIE BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5332
Country	:	US
Telephone Number	:	772-335-9465
Fax Number	:	772-335-9893

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

Provider Enumeration Date	:	01/25/2013
Last Update Date	:	01/25/2013

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Directions to “ TRYSTAL LAMPKIN ” Practice Location

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