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NPI Code Detail

MEDICARE: DR. SALLY A CUSHNIE PHARM.D.

MEDICARE:  DR. SALLY A CUSHNIE  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
11835P1200XPharmacotherapy PharmacistPS21626FL

General Provider Information

NPI Number : 1356339071
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SALLY A CUSHNIE PHARM.D.
Provider Business Mailing Address
First Line : 2448 IVY AVE
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-4347
Country : US
Telephone Number : 239-939-3939
Fax Number : 239-931-6109
Provider Business Practice Location Address
First Line : 3033 WINKLER AVENUE EXT
Second Line : VA OUTPATIENT CLINIC
City : FORT MYERS
State : FL
Zip : 33916-9413
Country : US
Telephone Number : 239-939-3939
Fax Number : 239-931-6109
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2005
Last Update Date : 07/08/2007

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