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NPI Code Detail

MEDICARE: DR. BRADLEY R STRACK PHARM.D

MEDICARE: DR. BRADLEY R STRACK PHARM.D
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
1183500000XPharmacistPS48300FL

General Provider Information

NPI Number : 1629352810
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRADLEY R STRACK PHARM.D
Provider Business Mailing Address
First Line : 16000 N CLEVELAND AVE
Second Line :
City : NORTH FORT MYERS
State : FL
Zip : 33903-2107
Country : US
Telephone Number : 239-656-3419
Fax Number : 239-656-3874
Provider Business Practice Location Address
First Line : 16000 N CLEVELAND AVE
Second Line :
City : NORTH FORT MYERS
State : FL
Zip : 33903-2107
Country : US
Telephone Number : 239-656-3419
Fax Number : 239-656-3874
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2011
Last Update Date : 10/05/2011

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