MEDICARE: MR. HARRY G HORODECK 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	PS0012646	FL
2	183500000X	Pharmacist	PU003519	FL

General Provider Information

NPI Number	:	1568738714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HARRY G HORODECK RPH

Provider Business Mailing Address
First Line	:	2636 NW 8TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-5734
Country	:	US
Telephone Number	:	239-989-9490
Fax Number	:

Provider Business Practice Location Address
First Line	:	2636 NW 8TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-5734
Country	:	US
Telephone Number	:	239-989-9490
Fax Number	:

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

Provider Enumeration Date	:	03/31/2012
Last Update Date	:	03/31/2012

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