MEDICARE: MR. ROBERT B WIDMER RPH

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	033611	NY

General Provider Information

NPI Number	:	1831185529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT B WIDMER RPH

Provider Business Mailing Address
First Line	:	1011 CARDIGAN LN
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-6004
Country	:	US
Telephone Number	:	727-789-1421
Fax Number	:

Provider Business Practice Location Address
First Line	:	10000 BAY PINES BLVD
Second Line	:
City	:	BAY PINES
State	:	FL
Zip	:	33744-8200
Country	:	US
Telephone Number	:	727-398-6661
Fax Number	:

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	06/17/2015

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