MEDICARE: SAMUEL DOR 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	PS53952	FL

General Provider Information

NPI Number	:	1487025987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL DOR PHARMACIST

Provider Business Mailing Address
First Line	:	2520 NE 8TH AVE
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33064-6405
Country	:	US
Telephone Number	:	954-245-2342
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 S FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-7240
Country	:	US
Telephone Number	:	954-784-3872
Fax Number	:

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

Provider Enumeration Date	:	10/12/2015
Last Update Date	:	10/12/2015

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