=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720410608
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA LYNN EISENMAN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2013
-----------------------------------------------------
Last Update Date | 08/02/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 686 GOLDEN BEACH DR
-----------------------------------------------------
City | GOLDEN BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160-2246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-494-9686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 686 GOLDEN BEACH DR
-----------------------------------------------------
City | GOLDEN BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160-2246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-494-9686
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P1200X
-----------------------------------------------------
Taxonomy Name | Pharmacotherapy Pharmacist
-----------------------------------------------------
License Number | PS50863
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------