MEDICARE: DR. DIEDRA SHANTEL ROBINSON 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	PS48059	FL

General Provider Information

NPI Number	:	1750985081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIEDRA SHANTEL ROBINSON PHARMD

Provider Business Mailing Address
First Line	:	1208 W JEFFERSON ST
Second Line	:
City	:	QUINCY
State	:	FL
Zip	:	32351-2126
Country	:	US
Telephone Number	:	850-875-3021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 W JEFFERSON ST
Second Line	:
City	:	QUINCY
State	:	FL
Zip	:	32351-2126
Country	:	US
Telephone Number	:	850-875-3021
Fax Number	:

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

Provider Enumeration Date	:	11/27/2020
Last Update Date	:	11/27/2020

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