MEDICARE: LEIGH P WIRTH 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
1	183500000X	Pharmacist	PS40210	FL

General Provider Information

NPI Number	:	1982941886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIGH P WIRTH PHARM D.

Provider Business Mailing Address
First Line	:	810 S US HIGHWAY 1
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-4703
Country	:	US
Telephone Number	:	772-778-7933
Fax Number	:	772-778-0057

Provider Business Practice Location Address
First Line	:	810 S US HIGHWAY 1
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32962-4703
Country	:	US
Telephone Number	:	772-778-7933
Fax Number	:	772-778-0057

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

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	04/15/2013

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