MEDICARE: NICHOLAS MICHAEL CAVIS RPH

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	PS47928	FL

General Provider Information

NPI Number	:	1558608232
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS MICHAEL CAVIS RPH

Provider Business Mailing Address
First Line	:	7310 MANATEE AVE W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-3441
Country	:	US
Telephone Number	:	941-792-6295
Fax Number	:	941-795-0520

Provider Business Practice Location Address
First Line	:	7310 MANATEE AVE W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34209-3441
Country	:	US
Telephone Number	:	941-792-6295
Fax Number	:	941-795-0520

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

Provider Enumeration Date	:	01/15/2013
Last Update Date	:	01/15/2013

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