MEDICARE: LUISA PODBER 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	PS28056	FL

General Provider Information

NPI Number	:	1427328053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUISA PODBER RPH

Provider Business Mailing Address
First Line	:	3109 VALENCIA LN E
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-4016
Country	:	US
Telephone Number	:	727-230-0467
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 VALENCIA LN E
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684
Country	:	US
Telephone Number	:	727-230-0467
Fax Number	:

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

Provider Enumeration Date	:	01/12/2012
Last Update Date	:	01/12/2012

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