MEDICARE: MS. PAMELA A DICRISTOFALO 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	PS32700	FL

General Provider Information

NPI Number	:	1265703763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA A DICRISTOFALO PHARMD

Provider Business Mailing Address
First Line	:	5742 CALMAR BREEZE LN
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4525
Country	:	US
Telephone Number	:	239-482-7113
Fax Number	:	239-482-0625

Provider Business Practice Location Address
First Line	:	5742 CALMAR BREEZE LN
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4525
Country	:	US
Telephone Number	:	239-482-7113
Fax Number	:

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

Provider Enumeration Date	:	01/16/2012
Last Update Date	:	01/16/2012

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