MEDICARE: DR. DUDLEY FLORESTAL 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	PS57121	FL

General Provider Information

NPI Number	:	1700395969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUDLEY FLORESTAL PHARMD

Provider Business Mailing Address
First Line	:	5036 SANCERRE CIR
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7452
Country	:	US
Telephone Number	:	561-602-7342
Fax Number	:

Provider Business Practice Location Address
First Line	:	4943 LE CHALET BLVD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33436-1405
Country	:	US
Telephone Number	:	561-602-7342
Fax Number	:

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

Provider Enumeration Date	:	09/20/2017
Last Update Date	:	09/20/2017

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