MEDICARE: BENJAMIN DAVID BUIE 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	PS0035873	FL

General Provider Information

NPI Number	:	1417236035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN DAVID BUIE PHARM.D.

Provider Business Mailing Address
First Line	:	2300 GRIFFIN RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-6760
Country	:	US
Telephone Number	:	863-858-5779
Fax Number	:	863-858-8960

Provider Business Practice Location Address
First Line	:	2300 GRIFFIN RD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-6760
Country	:	US
Telephone Number	:	863-858-5779
Fax Number	:	863-858-8960

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

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	08/12/2011

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