MEDICARE: MRS. LERYCKA FONTE PHARM.D.

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	PS36832	FL

General Provider Information

NPI Number	:	1295004059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LERYCKA FONTE PHARM.D.

Provider Business Mailing Address
First Line	:	18600 NW 87 AVE # 109
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33015-2918
Country	:	US
Telephone Number	:	305-405-3333
Fax Number	:	305-405-3334

Provider Business Practice Location Address
First Line	:	18600 NW 87 AVE # 109
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33015-2918
Country	:	US
Telephone Number	:	305-405-3333
Fax Number	:	305-405-3334

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

Provider Enumeration Date	:	12/23/2011
Last Update Date	:	12/23/2011

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