MEDICARE: EBONY DUCKWORTH HUMPHREY PHARM D

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	PS47762	FL

General Provider Information

NPI Number	:	1922609452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY DUCKWORTH HUMPHREY PHARM D

Provider Business Mailing Address
First Line	:	8134 WHITE PELICAN ST
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-8755
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16313 NEW INDEPENDENCE PKWY
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-8113
Country	:	US
Telephone Number	:	407-554-0181
Fax Number	:

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

Provider Enumeration Date	:	11/02/2020
Last Update Date	:	11/02/2020

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