MEDICARE: MR. RAYMOND P FOGLIA 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	PS021647	FL

General Provider Information

NPI Number	:	1922410133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAYMOND P FOGLIA RPH

Provider Business Mailing Address
First Line	:	1098 MONTGOMERY RD
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-7420
Country	:	US
Telephone Number	:	407-869-6463
Fax Number	:	407-869-7318

Provider Business Practice Location Address
First Line	:	1098 MONTGOMERY RD
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-7420
Country	:	US
Telephone Number	:	407-869-6463
Fax Number	:	407-869-7318

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

Provider Enumeration Date	:	05/21/2014
Last Update Date	:	05/21/2014

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