MEDICARE: MR. KEVIN PAUL DEGEN 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	PS31550	FL

General Provider Information

NPI Number	:	1033496146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN PAUL DEGEN RPH

Provider Business Mailing Address
First Line	:	1251 SW 40TH AVE
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33317-5805
Country	:	US
Telephone Number	:	954-584-2118
Fax Number	:	954-584-7451

Provider Business Practice Location Address
First Line	:	1251 SW 40TH AVE.
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33317-5805
Country	:	US
Telephone Number	:	954-584-2118
Fax Number	:	954-584-7451

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

Provider Enumeration Date	:	11/03/2011
Last Update Date	:	11/03/2011

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