MEDICARE: MRS. JODIE ANN LUMBRAZO 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	13470	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184872640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JODIE ANN LUMBRAZO RPH

Provider Business Mailing Address
First Line	:	70 CRAPE MYRTLE DR STE 103
Second Line	:
City	:	BENSON
State	:	NC
Zip	:	27504-8034
Country	:	US
Telephone Number	:	919-938-3800
Fax Number	:	919-938-3801

Provider Business Practice Location Address
First Line	:	70 CRAPE MYRTLE DR STE 103
Second Line	:
City	:	BENSON
State	:	NC
Zip	:	27504-8034
Country	:	US
Telephone Number	:	919-938-3800
Fax Number	:	919-938-3801

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

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	09/08/2008

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