MEDICARE: DR. JULIA ANNE NICKERSON-TROY MS, 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	PS36642	FL

General Provider Information

NPI Number	:	1750374856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIA ANNE NICKERSON-TROY MS, PHARMD

Provider Business Mailing Address
First Line	:	4956 MENDAVIA DR
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33872-9002
Country	:	US
Telephone Number	:	407-303-4665
Fax Number	:	407-303-4443

Provider Business Practice Location Address
First Line	:	400 CELEBRATION PL
Second Line	:
City	:	CELEBRATION
State	:	FL
Zip	:	34747-4970
Country	:	US
Telephone Number	:	407-303-4665
Fax Number	:	407-303-4443

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/08/2007

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