Healthcare Provider Details

I. General information

NPI: 1730438086
Provider Name (Legal Business Name): ANDREW MICHAEL MARGOLIS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2012
Last Update Date: 09/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 LITTLE RD
TRINITY FL
34655-5301
US

IV. Provider business mailing address

1841 LITTLE RD
TRINITY FL
34655-5301
US

V. Phone/Fax

Practice location:
  • Phone: 727-375-2077
  • Fax:
Mailing address:
  • Phone: 727-375-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS49038
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: