MEDICARE: ST LUKE PHARMACY CORP

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	3336C0003X	Community/Retail Pharmacy	PH25416	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2135137	OTHER		PK

General Provider Information

NPI Number	:	1831458868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST LUKE PHARMACY CORP

Provider Business Mailing Address
First Line	:	2019 GULF TO BAY BLVD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33765-3703
Country	:	US
Telephone Number	:	727-754-7851
Fax Number	:	727-754-7852

Provider Business Practice Location Address
First Line	:	2019 GULF TO BAY BLVD
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33765-3703
Country	:	US
Telephone Number	:	727-754-7851
Fax Number	:	727-754-7852

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN MUSALLAM
Credential	:
Telephone Number	:	727-754-7851

Provider Enumeration Date	:	05/11/2012
Last Update Date	:	07/13/2015

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Directions to “ST LUKE PHARMACY CORP ” Practice Location

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