MEDICARE: RANDI KROUSKOS

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	PS51880	FL

General Provider Information

NPI Number	:	1518376052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDI KROUSKOS

Provider Business Mailing Address
First Line	:	2040 SHEPHERD RD
Second Line	:
City	:	MULBERRY
State	:	FL
Zip	:	33860-8699
Country	:	US
Telephone Number	:	863-644-5929
Fax Number	:	863-644-2209

Provider Business Practice Location Address
First Line	:	2040 SHEPHERD RD
Second Line	:
City	:	MULBERRY
State	:	FL
Zip	:	33860-8699
Country	:	US
Telephone Number	:	863-644-5929
Fax Number	:	863-644-2209

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

Provider Enumeration Date	:	08/08/2014
Last Update Date	:	08/08/2014

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Directions to “ RANDI KROUSKOS ” Practice Location

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