MEDICARE: BUDDY KYLE CHESNUT RPH

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	PS32914	FL

General Provider Information

NPI Number	:	1396083762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BUDDY KYLE CHESNUT RPH

Provider Business Mailing Address
First Line	:	11240 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2449
Country	:	US
Telephone Number	:	850-233-4590
Fax Number	:

Provider Business Practice Location Address
First Line	:	11240 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2449
Country	:	US
Telephone Number	:	850-233-4590
Fax Number	:

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

Provider Enumeration Date	:	01/19/2013
Last Update Date	:	01/19/2013

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