MEDICARE: KIMBERLY ANN CORONADO C PHT

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	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1568678712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN CORONADO C PHT

Provider Business Mailing Address
First Line	:	5200 NW 31ST AVE #99
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309
Country	:	US
Telephone Number	:	954-793-8552
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 S MILITARY TRL
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-7645
Country	:	US
Telephone Number	:	954-421-4349
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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