MEDICARE: MARTINA PRUSAC RPH

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	PS56733	FL

General Provider Information

NPI Number	:	1023536703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTINA PRUSAC RPH

Provider Business Mailing Address
First Line	:	7333 PARK BLVD N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-2922
Country	:	US
Telephone Number	:	727-546-5866
Fax Number	:

Provider Business Practice Location Address
First Line	:	7333 PARK BLVD N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-2922
Country	:	US
Telephone Number	:	727-546-7791
Fax Number	:

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

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	09/01/2017

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Directions to “ MARTINA PRUSAC RPH” Practice Location

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