MEDICARE: DUSTIN LOCKE PHARMD

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	PS56702	FL

General Provider Information

NPI Number	:	1558904425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN LOCKE PHARMD

Provider Business Mailing Address
First Line	:	725 N TYNDALL PKWY
Second Line	:
City	:	CALLAWAY
State	:	FL
Zip	:	32404-3219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 N TYNDALL PKWY
Second Line	:
City	:	CALLAWAY
State	:	FL
Zip	:	32404-3219
Country	:	US
Telephone Number	:	850-785-0021
Fax Number	:

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

Provider Enumeration Date	:	10/23/2019
Last Update Date	:	10/23/2019

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Directions to “ DUSTIN LOCKE PHARMD” Practice Location

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