MEDICARE: ERISA HYSTUNA

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	PS63358	FL

General Provider Information

NPI Number	:	1932867645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERISA HYSTUNA

Provider Business Mailing Address
First Line	:	2742 WOODRING DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-1737
Country	:	US
Telephone Number	:	727-953-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	1921 N BELCHER RD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33763-4548
Country	:	US
Telephone Number	:	727-712-3450
Fax Number	:

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

Provider Enumeration Date	:	11/30/2021
Last Update Date	:	11/30/2021

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