MEDICARE: MR. TEODORO LUNA PHARMD

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 35058	FL

General Provider Information

NPI Number	:	1457680068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TEODORO LUNA PHARMD

Provider Business Mailing Address
First Line	:	14142 POPCORN TREE CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-6416
Country	:	US
Telephone Number	:	407-737-2799
Fax Number	:

Provider Business Practice Location Address
First Line	:	6435 HAZELTINE NATIONAL DR STE 140
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-5156
Country	:	US
Telephone Number	:	321-281-3111
Fax Number	:

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

Provider Enumeration Date	:	12/09/2009
Last Update Date	:	12/09/2009

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