MEDICARE: ELIZABETH PREBLE RPH

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	S008635	AZ

General Provider Information

NPI Number	:	1144515081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH PREBLE RPH

Provider Business Mailing Address
First Line	:	5255 E BROADWAY BLVD
Second Line	:	T-0179
City	:	TUCSON
State	:	AZ
Zip	:	85711-3702
Country	:	US
Telephone Number	:	520-917-0130
Fax Number	:	520-917-0130

Provider Business Practice Location Address
First Line	:	5255 E BROADWAY BLVD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3702
Country	:	US
Telephone Number	:	520-917-0130
Fax Number	:	520-917-0130

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

Provider Enumeration Date	:	06/17/2011
Last Update Date	:	06/17/2011

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