MEDICARE: VITA MAKAR

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	PS61529	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS61529	OTHER	FL	PHARMACIST
2	PS61529	OTHER	FL	PHARMACIST LICENSE

General Provider Information

NPI Number	:	1932713872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VITA MAKAR

Provider Business Mailing Address
First Line	:	3830 S NOVA RD STE C4
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-9205
Country	:	US
Telephone Number	:	386-238-9734
Fax Number	:

Provider Business Practice Location Address
First Line	:	3830 S NOVA RD STE C4
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-9205
Country	:	US
Telephone Number	:	386-238-9734
Fax Number	:

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

Provider Enumeration Date	:	09/08/2020
Last Update Date	:	09/08/2020

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Directions to “ VITA MAKAR ” Practice Location

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