MEDICARE: DR. MAUREEN SMITH LONGWORTH PHARM D

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	PS43106	FL

General Provider Information

NPI Number	:	1528306925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAUREEN SMITH LONGWORTH PHARM D

Provider Business Mailing Address
First Line	:	2125 E COUNTY ROAD 540A
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3794
Country	:	US
Telephone Number	:	863-619-8332
Fax Number	:	863-619-7993

Provider Business Practice Location Address
First Line	:	2125 E COUNTY ROAD 540A
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3794
Country	:	US
Telephone Number	:	863-619-8332
Fax Number	:	863-619-7993

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

Provider Enumeration Date	:	01/21/2013
Last Update Date	:	01/21/2013

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