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NPI Code Detail

MEDICARE: DR. KENNY ROMUALD ARISTIDE PHARM.D.

MEDICARE: DR. KENNY ROMUALD ARISTIDE PHARM.D.
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
1183500000XPharmacistPS 49423FL

General Provider Information

NPI Number : 1578811212
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNY ROMUALD ARISTIDE PHARM.D.
Provider Business Mailing Address
First Line : 2890 71ST CIR
Second Line : APT # 208
City : VERO BEACH
State : FL
Zip : 32966-8922
Country : US
Telephone Number : 407-376-4569
Fax Number :
Provider Business Practice Location Address
First Line : 10000 SW INNOVATION WAY
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34987-2111
Country : US
Telephone Number : 772-223-5945
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/28/2012
Last Update Date : 01/07/2014

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