MEDICARE: DR. KELLY EMBREE 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	PS37806	FL

General Provider Information

NPI Number	:	1639291537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY EMBREE PHARMD

Provider Business Mailing Address
First Line	:	2873 SAINT AUGUSTINE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32825-7141
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1921 S ALAFAYA TRL
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-8732
Country	:	US
Telephone Number	:	407-277-6608
Fax Number	:	407-277-0816

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

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	06/24/2013

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