MEDICARE: MR. GAYLON E. FRUIT 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	1835P1200X	Pharmacotherapy Pharmacist	PS15946	FL

General Provider Information

NPI Number	:	1447259288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GAYLON E. FRUIT RPH

Provider Business Mailing Address
First Line	:	3313 DARTMOOR DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1448
Country	:	US
Telephone Number	:	850-907-1209
Fax Number	:	850-386-3643

Provider Business Practice Location Address
First Line	:	3313 DARTMOOR DR
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-1448
Country	:	US
Telephone Number	:	850-907-1209
Fax Number	:	850-386-3643

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	07/08/2007

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