MEDICARE: KATHERINE SHIPLEY

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	PS40097	FL

General Provider Information

NPI Number	:	1609113372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE SHIPLEY

Provider Business Mailing Address
First Line	:	5375 N SOCRUM LOOP RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-4272
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5375 N SOCRUM LOOP RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33809-4272
Country	:	US
Telephone Number	:	863-859-6353
Fax Number	:

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

Provider Enumeration Date	:	01/14/2013
Last Update Date	:	01/14/2013

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Directions to “ KATHERINE SHIPLEY ” Practice Location

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