MEDICARE: PHILIP JAY ALSTEN 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	1835P2201X	Ambulatory Care Pharmacist	PS19628	FL

General Provider Information

NPI Number	:	1588264568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIP JAY ALSTEN RPH.

Provider Business Mailing Address
First Line	:	3000 NE 34TH ST
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-8558
Country	:	US
Telephone Number	:	954-801-2896
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 S FEDERAL HWY STE D
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4170
Country	:	US
Telephone Number	:	954-531-0211
Fax Number	:	954-531-0241

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

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/28/2020

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