MEDICARE: CARLOS DAVID SPIKES

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	PS0017725	FL

General Provider Information

NPI Number	:	1922447150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS DAVID SPIKES

Provider Business Mailing Address
First Line	:	3742 SW COQUINA COVE WAY APT 106
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-8179
Country	:	US
Telephone Number	:	772-220-9559
Fax Number	:	772-220-9559

Provider Business Practice Location Address
First Line	:	1891 N US HIGHWAY 1
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34946-1449
Country	:	US
Telephone Number	:	772-461-7049
Fax Number	:	772-461-7029

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

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	06/20/2013

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