MEDICARE: CARIN D BRALTS

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	PS49938	FL

General Provider Information

NPI Number	:	1588900104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARIN D BRALTS

Provider Business Mailing Address
First Line	:	342 E ROYAL PALM ST
Second Line	:
City	:	LAKE PLACID
State	:	FL
Zip	:	33852-5019
Country	:	US
Telephone Number	:	863-449-1006
Fax Number	:

Provider Business Practice Location Address
First Line	:	342 E ROYAL PALM ST
Second Line	:
City	:	LAKE PLACID
State	:	FL
Zip	:	33852-5019
Country	:	US
Telephone Number	:	863-449-1006
Fax Number	:

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

Provider Enumeration Date	:	12/31/2012
Last Update Date	:	08/12/2015

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