MEDICARE: DR. MOULAYE IDRISSA KONE 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	PS49211	FL

General Provider Information

NPI Number	:	1174929913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOULAYE IDRISSA KONE PHARM. D

Provider Business Mailing Address
First Line	:	7095 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2291
Country	:	US
Telephone Number	:	813-884-4884
Fax Number	:	813-886-1690

Provider Business Practice Location Address
First Line	:	7095 W WATERS AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2291
Country	:	US
Telephone Number	:	813-884-4884
Fax Number	:	813-886-1690

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

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	11/05/2014

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