MEDICARE: DR. OMA VANESSA PRAG

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	PS60273	FL

General Provider Information

NPI Number	:	1487259818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OMA VANESSA PRAG

Provider Business Mailing Address
First Line	:	4780 N KINGS HWY
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-4035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4780 N KINGS HWY
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34951-4035
Country	:	US
Telephone Number	:	772-489-2100
Fax Number	:

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

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	12/03/2020

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