MEDICARE: VICTORIA R TUNNICLIFFE 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
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PS31568	FL

General Provider Information

NPI Number	:	1609111566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA R TUNNICLIFFE PHARM D

Provider Business Mailing Address
First Line	:	4001 N OCEAN DR STE 105
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-5968
Country	:	US
Telephone Number	:	954-771-4000
Fax Number	:	954-337-0157

Provider Business Practice Location Address
First Line	:	4001 N OCEAN DR STE 105
Second Line	:
City	:	LAUDERDALE BY THE SEA
State	:	FL
Zip	:	33308-5968
Country	:	US
Telephone Number	:	954-771-4000
Fax Number	:	954-337-0157

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

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	12/04/2012

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