MEDICARE: JOSEPH WAYNE CRAGER PHARMACIST

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	PS19090	FL

General Provider Information

NPI Number	:	1467799544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH WAYNE CRAGER PHARMACIST

Provider Business Mailing Address
First Line	:	242 N ORLANDO AVE
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-5506
Country	:	US
Telephone Number	:	407-599-0210
Fax Number	:	407-599-0436

Provider Business Practice Location Address
First Line	:	242 N ORLANDO AVE
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-5506
Country	:	US
Telephone Number	:	407-599-0210
Fax Number	:	407-599-0436

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

Provider Enumeration Date	:	01/10/2013
Last Update Date	:	01/10/2013

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