MEDICARE: OSMEL LORETO MAESTRE

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	PS53840	FL

General Provider Information

NPI Number	:	1609247584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OSMEL LORETO MAESTRE

Provider Business Mailing Address
First Line	:	1136 W MOUNTAIN DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-4932
Country	:	US
Telephone Number	:	561-827-2967
Fax Number	:

Provider Business Practice Location Address
First Line	:	5970 S JOG RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-6590
Country	:	US
Telephone Number	:	561-649-7415
Fax Number	:

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

Provider Enumeration Date	:	10/17/2015
Last Update Date	:	09/21/2020

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