MEDICARE: SUSAN W FROST RPH

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	PS13680	FL

General Provider Information

NPI Number	:	1255468559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN W FROST RPH

Provider Business Mailing Address
First Line	:	1537 OAK TREE CT
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32712-2526
Country	:	US
Telephone Number	:	407-758-4108
Fax Number	:

Provider Business Practice Location Address
First Line	:	187 SABAL PALM DR
Second Line	:	STE. 100
City	:	LONGWOOD
State	:	FL
Zip	:	32779-2595
Country	:	US
Telephone Number	:	407-478-2799
Fax Number	:

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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