MEDICARE: MR. WILMER TIRADO 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	051844	NY
2	183500000X	Pharmacist	4921	PR
3	183500000X	Pharmacist	RP0008073	WV
4	183500000X	Pharmacist	RP450079	PA
5	183500000X	Pharmacist	PH235789	MA
6	1835N0905X	Nuclear Pharmacist	NP305	FL
7	1835N0905X	Nuclear Pharmacist	006	PR
8	183500000X	Pharmacist	PS35519	FL

General Provider Information

NPI Number	:	1255325544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILMER TIRADO PHARMD

Provider Business Mailing Address
First Line	:	9374 SW 173RD TER
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-5724
Country	:	US
Telephone Number	:	305-213-9241
Fax Number	:

Provider Business Practice Location Address
First Line	:	9374 SW 173RD TER
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33157-5724
Country	:	US
Telephone Number	:	305-213-9241
Fax Number	:

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	01/26/2021

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