MEDICARE: CURTIS HEARN RPH CPH

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	1835P2201X	Ambulatory Care Pharmacist	PS32315	FL

General Provider Information

NPI Number	:	1619329810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CURTIS HEARN RPH CPH

Provider Business Mailing Address
First Line	:	2113 W LAKEVIEW BLVD
Second Line	:
City	:	N FORT MYERS
State	:	FL
Zip	:	33903-5813
Country	:	US
Telephone Number	:	239-841-0235
Fax Number	:	239-424-2466

Provider Business Practice Location Address
First Line	:	2113 W LAKEVIEW BLVD
Second Line	:
City	:	N FORT MYERS
State	:	FL
Zip	:	33903-5813
Country	:	US
Telephone Number	:	239-841-0235
Fax Number	:	239-424-2466

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

Provider Enumeration Date	:	07/12/2016
Last Update Date	:	07/12/2016

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