MEDICARE: MRS. CONNIE JEAN GARRELTS R.PH

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	PS23652	FL

General Provider Information

NPI Number	:	1255678827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CONNIE JEAN GARRELTS R.PH

Provider Business Mailing Address
First Line	:	2160 MCGREGOR BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-3417
Country	:	US
Telephone Number	:	239-332-4881
Fax Number	:	239-332-4468

Provider Business Practice Location Address
First Line	:	2160 MCGREGOR BLVD
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-3417
Country	:	US
Telephone Number	:	239-332-4881
Fax Number	:	239-332-4468

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

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	01/15/2013

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