MEDICARE: DEVORA D BUSTAMANTE

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	PS69193	FL

General Provider Information

NPI Number	:	1760326169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVORA D BUSTAMANTE

Provider Business Mailing Address
First Line	:	2145 WHITE PINE CIR APT C
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33415-6064
Country	:	US
Telephone Number	:	561-231-4485
Fax Number	:

Provider Business Practice Location Address
First Line	:	2145 WHITE PINE CIR APT C
Second Line	:
City	:	GREENACRES
State	:	FL
Zip	:	33415-6064
Country	:	US
Telephone Number	:	561-231-4485
Fax Number	:

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

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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Directions to “ DEVORA D BUSTAMANTE ” Practice Location

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