MEDICARE: MR. WAYNE ELLIOTT GIBBS

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	PS26202	FL

General Provider Information

NPI Number	:	1245509314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WAYNE ELLIOTT GIBBS

Provider Business Mailing Address
First Line	:	13502 S APOPKA VINELAND RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-6321
Country	:	US
Telephone Number	:	407-827-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	13502 S APOPKA VINELAND RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-6321
Country	:	US
Telephone Number	:	407-827-1000
Fax Number	:

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

Provider Enumeration Date	:	12/20/2011
Last Update Date	:	12/20/2011

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