MEDICARE: DR. DOMINIC FRANK BEOVICH IV 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	PS52198	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS52198	OTHER	FL	STATE PHARMACIST LICENSE

General Provider Information

NPI Number	:	1023426467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOMINIC FRANK BEOVICH IV PHARM.D.

Provider Business Mailing Address
First Line	:	6350 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-7823
Country	:	US
Telephone Number	:	407-447-6546
Fax Number	:

Provider Business Practice Location Address
First Line	:	6350 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-7823
Country	:	US
Telephone Number	:	407-447-6546
Fax Number	:

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

Provider Enumeration Date	:	07/29/2014
Last Update Date	:	02/09/2015

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