MEDICARE: DR. KRISTEN RENEE CARL 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	PS39098	FL

General Provider Information

NPI Number	:	1346831153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN RENEE CARL PHARMD

Provider Business Mailing Address
First Line	:	2573 GALIANO AVE SW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32908-1355
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3690 NW 53RD ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-2452
Country	:	US
Telephone Number	:	866-209-2178
Fax Number	:

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

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	02/03/2021

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