MEDICARE: ANTOLEE WALTERS

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	PS47384	FL

General Provider Information

NPI Number	:	1629455399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOLEE WALTERS

Provider Business Mailing Address
First Line	:	1010 W FLAGLER ST
Second Line	:	T-2848
City	:	MIAMI
State	:	FL
Zip	:	33130-1032
Country	:	US
Telephone Number	:	305-894-2938
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 W FLAGLER ST
Second Line	:	T-2848
City	:	MIAMI
State	:	FL
Zip	:	33130-1032
Country	:	US
Telephone Number	:	305-894-2938
Fax Number	:

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

Provider Enumeration Date	:	05/01/2015
Last Update Date	:	05/01/2015

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Directions to “ ANTOLEE WALTERS ” Practice Location

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