MEDICARE: LINCOURT COMPOUNDING CENTER

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	3336C0004X	Compounding Pharmacy	PH24418	FL

General Provider Information

NPI Number	:	1699070425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LINCOURT COMPOUNDING CENTER

Provider Business Mailing Address
First Line	:	501 S LINCOLN AVE
Second Line	:	SUITE 23
City	:	CLEARWATER
State	:	FL
Zip	:	33756-5945
Country	:	US
Telephone Number	:	727-479-3046
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 S LINCOLN AVE
Second Line	:	SUITE 23
City	:	CLEARWATER
State	:	FL
Zip	:	33756-5945
Country	:	US
Telephone Number	:	727-479-3046
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LOUIS F LADSON
Credential	:	R.PH
Telephone Number	:	727-479-3046

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	01/26/2011

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Directions to “LINCOURT COMPOUNDING CENTER ” Practice Location

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