MEDICARE: PETE SENCHYSHAK 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	PS48870	FL
2	183500000X	Pharmacist	RP037665L	PA
3	183500000X	Pharmacist	03127744	OH
4	183500000X	Pharmacist	PH14046	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS48870	OTHER	FL	FLORIDA PHARMACY LICENSE

General Provider Information

NPI Number	:	1922403591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETE SENCHYSHAK RPH

Provider Business Mailing Address
First Line	:	2438 LAUREL RD E
Second Line	:
City	:	NORTH VENICE
State	:	FL
Zip	:	34275-3204
Country	:	US
Telephone Number	:	941-488-2459
Fax Number	:	941-234-0986

Provider Business Practice Location Address
First Line	:	2438 LAUREL RD E
Second Line	:
City	:	NORTH VENICE
State	:	FL
Zip	:	34275-3204
Country	:	US
Telephone Number	:	941-488-2459
Fax Number	:	941-234-0986

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

Provider Enumeration Date	:	10/25/2014
Last Update Date	:	10/25/2014

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