MEDICARE: DR. KINGSTON LLOYD BALDIE 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	PS48013	FL

General Provider Information

NPI Number	:	1821368325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KINGSTON LLOYD BALDIE PHARMD

Provider Business Mailing Address
First Line	:	4121 E BUSCH BLVD APT 521
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-5968
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2760 S FALKENBURG RD
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-2561
Country	:	US
Telephone Number	:	813-877-4365
Fax Number	:

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

Provider Enumeration Date	:	12/31/2011
Last Update Date	:	12/31/2011

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