MEDICARE: DR. DALLAS STOVER 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	PS66107	FL

General Provider Information

NPI Number	:	1679256903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALLAS STOVER PHARMD

Provider Business Mailing Address
First Line	:	3840 OAKHILL DR
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-3523
Country	:	US
Telephone Number	:	321-505-8199
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 CHENEY HWY
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-6028
Country	:	US
Telephone Number	:	321-267-9611
Fax Number	:

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

Provider Enumeration Date	:	08/11/2023
Last Update Date	:	08/11/2023

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Directions to “ DR. DALLAS STOVER PHARMD” Practice Location

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