MEDICARE: DR. LOREWELL DAGDAYAN BUAYA PHARMD

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	21398-40	WI

General Provider Information

NPI Number	:	1336877737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOREWELL DAGDAYAN BUAYA PHARMD

Provider Business Mailing Address
First Line	:	310 18TH AVE APT 8
Second Line	:
City	:	UNION GROVE
State	:	WI
Zip	:	53182-1809
Country	:	US
Telephone Number	:	630-401-5541
Fax Number	:

Provider Business Practice Location Address
First Line	:	819 N MEMORIAL DR
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53404-3270
Country	:	US
Telephone Number	:	262-637-4900
Fax Number	:	262-637-7148

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

Provider Enumeration Date	:	08/12/2022
Last Update Date	:	12/21/2022

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