MEDICARE: DR. TINA LOUISE GELLMAN 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	PS48745	FL

General Provider Information

NPI Number	:	1578171278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINA LOUISE GELLMAN PHARMD

Provider Business Mailing Address
First Line	:	3011 NE 40TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5829
Country	:	US
Telephone Number	:	410-963-3818
Fax Number	:

Provider Business Practice Location Address
First Line	:	3011 NE 40TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5829
Country	:	US
Telephone Number	:	410-963-3818
Fax Number	:

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

Provider Enumeration Date	:	07/19/2020
Last Update Date	:	07/19/2020

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