=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043610470
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICHOLAS A GARCIA PHARMD, RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2014
-----------------------------------------------------
Last Update Date | 09/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5407 OVERSEAS HWY
-----------------------------------------------------
City | MARATHON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33050-2710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-289-3192
-----------------------------------------------------
Fax | 305-289-9281
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 510835
-----------------------------------------------------
City | KEY COLONY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33051-0835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-461-1336
-----------------------------------------------------
Fax | 305-289-9281
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS46806
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------