MEDICARE: DR. BARBARA LOUISE COLLETTE 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	PS37734	FL
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PS37734	FL

General Provider Information

NPI Number	:	1245506013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA LOUISE COLLETTE PHARMD

Provider Business Mailing Address
First Line	:	217 DINNER LAKE LOOP
Second Line	:	LAKE WALES
City	:	LAKE WALES
State	:	FL
Zip	:	33859-2153
Country	:	US
Telephone Number	:	407-908-3806
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 DINNER LAKE LOOP
Second Line	:	LAKE WALES
City	:	LAKE WALES
State	:	FL
Zip	:	33859-2153
Country	:	US
Telephone Number	:	407-908-3806
Fax Number	:

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

Provider Enumeration Date	:	03/27/2012
Last Update Date	:	03/27/2012

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