MEDICARE: FARLEY SAINT-LOUIS RPH

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	PS58266	FL

General Provider Information

NPI Number	:	1700480886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARLEY SAINT-LOUIS RPH

Provider Business Mailing Address
First Line	:	11251 SW 20TH ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-6637
Country	:	US
Telephone Number	:	954-802-1872
Fax Number	:

Provider Business Practice Location Address
First Line	:	16001 MIRAMAR PKWY
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-4563
Country	:	US
Telephone Number	:	954-435-3935
Fax Number	:	954-435-1810

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

Provider Enumeration Date	:	11/30/2020
Last Update Date	:	11/30/2020

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