=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750774360
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHEILA KYBURZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2015
-----------------------------------------------------
Last Update Date | 03/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1202 W MAIN ST
-----------------------------------------------------
City | INVERNESS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34450-4634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-726-8415
-----------------------------------------------------
Fax | 352-726-8837
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1202 W MAIN ST
-----------------------------------------------------
City | INVERNESS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34450-4634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-726-8415
-----------------------------------------------------
Fax | 352-726-8837
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS20680
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------