MEDICARE: MRS. JADE A PINTA 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	PS 15498	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PU 3259	OTHER	FL	CONSULTANT PHARMACIST

General Provider Information

NPI Number	:	1417130469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JADE A PINTA RPH

Provider Business Mailing Address
First Line	:	5703 INVERNESS CIR
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-5811
Country	:	US
Telephone Number	:	239-995-5007
Fax Number	:

Provider Business Practice Location Address
First Line	:	5703 INVERNESS CIR
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-5811
Country	:	US
Telephone Number	:	239-995-5007
Fax Number	:

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

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	12/14/2007

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