MEDICARE: MR. DALE GRANT LARKINS PHARM.D

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	PS27665	FL

General Provider Information

NPI Number	:	1801165725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DALE GRANT LARKINS PHARM.D

Provider Business Mailing Address
First Line	:	7650 W SAND LAKE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-5112
Country	:	US
Telephone Number	:	407-370-6742
Fax Number	:	407-345-5463

Provider Business Practice Location Address
First Line	:	7650 W SAND LAKE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-5112
Country	:	US
Telephone Number	:	407-370-6742
Fax Number	:	407-345-5463

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

Provider Enumeration Date	:	12/21/2011
Last Update Date	:	12/21/2011

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