MEDICARE: LAZARO VU

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	26021270A	IN

General Provider Information

NPI Number	:	1376827550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAZARO VU

Provider Business Mailing Address
First Line	:	1120 HARBOR POINT ROAD
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47803
Country	:	US
Telephone Number	:	812-841-3187
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 WABASH AVENUE
Second Line	:
City	:	TERRE HAUTE
State	:	IN
Zip	:	47807
Country	:	US
Telephone Number	:	812-234-5147
Fax Number	:

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

Provider Enumeration Date	:	10/05/2011
Last Update Date	:	10/05/2011

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Directions to “ LAZARO VU ” Practice Location

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