MEDICARE: DR. LYSANDRA HALL 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	5395	PR
2	183500000X	Pharmacist	PS55584	FL

General Provider Information

NPI Number	:	1215289657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYSANDRA HALL PHARMD

Provider Business Mailing Address
First Line	:	16313 NEW INDEPENDENCE PKWY
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-8113
Country	:	US
Telephone Number	:	407-554-0181
Fax Number	:

Provider Business Practice Location Address
First Line	:	4520 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-2408
Country	:	US
Telephone Number	:	407-563-9170
Fax Number	:

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

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	05/06/2023

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