MEDICARE: ANGELA KUTANJAC

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	PS46912	FL

General Provider Information

NPI Number	:	1134467525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA KUTANJAC

Provider Business Mailing Address
First Line	:	3901 S OCEAN DR
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-3016
Country	:	US
Telephone Number	:	954-703-0758
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 E HALLANDALE BEACH BLVD
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4617
Country	:	US
Telephone Number	:	954-454-8825
Fax Number	:

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

Provider Enumeration Date	:	01/21/2013
Last Update Date	:	01/21/2013

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