MEDICARE: DR. DENNIS R SIBLEY II 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	PS46474	FL

General Provider Information

NPI Number	:	1619259694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS R SIBLEY II PHARMD

Provider Business Mailing Address
First Line	:	11874 FITCHWOOD CIR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-4505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 N PONCE DELEON BLVD
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32084
Country	:	US
Telephone Number	:	904-810-2200
Fax Number	:

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

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	09/15/2011

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