MEDICARE: MISS RACEY LASHAY TARVER CPHT

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	183700000X	Pharmacy Technician	RPT18137	FL

General Provider Information

NPI Number	:	1811608185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS RACEY LASHAY TARVER CPHT

Provider Business Mailing Address
First Line	:	5036 LIMING AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-1658
Country	:	US
Telephone Number	:	407-493-8504
Fax Number	:

Provider Business Practice Location Address
First Line	:	6217 SILVER STAR RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32808-4229
Country	:	US
Telephone Number	:	407-298-0404
Fax Number	:

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

Provider Enumeration Date	:	12/07/2022
Last Update Date	:	12/07/2022

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