MEDICARE: DR. ELVIN MONTANEZ PHARMD

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	PS26914	FL
2	1835N1003X	Nutrition Support Pharmacist	PS26914	FL
3	1835P1200X	Pharmacotherapy Pharmacist	PS 26914	FL
4	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PS26914	FL

General Provider Information

NPI Number	:	1053663237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELVIN MONTANEZ PHARMD

Provider Business Mailing Address
First Line	:	376 NORTHLAKE BLVD
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5261
Country	:	US
Telephone Number	:	407-830-8820
Fax Number	:

Provider Business Practice Location Address
First Line	:	376 NORTHLAKE BLVD
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-5261
Country	:	US
Telephone Number	:	407-830-8820
Fax Number	:

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

Provider Enumeration Date	:	10/11/2012
Last Update Date	:	05/27/2021

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