MEDICARE: RICHARD LAVOSKY III 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	PS64719	FL

General Provider Information

NPI Number	:	1548989197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD LAVOSKY III PHARMD

Provider Business Mailing Address
First Line	:	400 NW 24TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-4434
Country	:	US
Telephone Number	:	904-679-2805
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 NW 126TH AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2408
Country	:	US
Telephone Number	:	888-224-5181
Fax Number	:

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

Provider Enumeration Date	:	08/25/2022
Last Update Date	:	08/25/2022

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