MEDICARE: DR. DIPTIBEN SMART

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	PS33664	FL

General Provider Information

NPI Number	:	1497347546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIPTIBEN SMART

Provider Business Mailing Address
First Line	:	320 ANCONA AVE
Second Line	:
City	:	DEBARY
State	:	FL
Zip	:	32713-5413
Country	:	US
Telephone Number	:	321-695-4422
Fax Number	:	386-218-4913

Provider Business Practice Location Address
First Line	:	2413 ENTERPRISE RD
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-7964
Country	:	US
Telephone Number	:	386-218-4993
Fax Number	:	386-218-4913

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

Provider Enumeration Date	:	02/10/2021
Last Update Date	:	02/10/2021

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