MEDICARE: GLORIA ANNE MINER

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	6163732	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSI32775	OTHER	FL	FLORIDA DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1508255183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA ANNE MINER

Provider Business Mailing Address
First Line	:	8453 GARDENS CIR APT 14
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34243-3083
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8453 GARDENS CIR APT 14
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34243-3083
Country	:	US
Telephone Number	:	815-519-9125
Fax Number	:

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

Provider Enumeration Date	:	01/20/2015
Last Update Date	:	01/23/2015

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Directions to “ GLORIA ANNE MINER ” Practice Location

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