MEDICARE: DR. TIERRA ROSSIN 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	55360	FL

General Provider Information

NPI Number	:	1609320696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIERRA ROSSIN PHARMD

Provider Business Mailing Address
First Line	:	2355 NE 26TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33305-1628
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 NE 26TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33305-1628
Country	:	US
Telephone Number	:	954-561-3880
Fax Number	:

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

Provider Enumeration Date	:	08/08/2016
Last Update Date	:	08/08/2016

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