MEDICARE: SCOTT ALAN DERSHEM PHARMACIST

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	PS60336	FL

General Provider Information

NPI Number	:	1194320895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT ALAN DERSHEM PHARMACIST

Provider Business Mailing Address
First Line	:	99434 OVERSEAS HWY
Second Line	:
City	:	KEY LARGO
State	:	FL
Zip	:	33037-2459
Country	:	US
Telephone Number	:	351-405-3261
Fax Number	:

Provider Business Practice Location Address
First Line	:	99434 OVERSEAS HWY
Second Line	:
City	:	KEY LARGO
State	:	FL
Zip	:	33037-2459
Country	:	US
Telephone Number	:	305-451-3261
Fax Number	:

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

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/01/2020

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