Individual
AUSTIN TYLER LOFTHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7800 LAKE WILSON RD, DAVENPORT, FL 33896-9605
(863) 420-4236
Mailing address
6703 2ND AVENUE CIR W, BRADENTON, FL 34209-2218
(941) 773-7816
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS57018
FL
Other
Enumeration date
09/16/2017
Last updated
09/16/2017
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