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NPI Code Detail

MEDICARE: KATINA FASUL

MEDICARE:   KATINA  FASUL
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
1183500000XPharmacistPS26760FL

General Provider Information

NPI Number : 1942803663
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATINA FASUL
Provider Business Mailing Address
First Line : 141 E WOOLBRIGHT RD
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33435-6007
Country : US
Telephone Number : 561-736-1010
Fax Number :
Provider Business Practice Location Address
First Line : 141 E WOOLBRIGHT RD
Second Line :
City : BOYNTON BEACH
State : FL
Zip : 33435-6007
Country : US
Telephone Number : 561-736-1010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2020
Last Update Date : 11/17/2020

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Directions to “ KATINA FASUL ” Practice Location

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