MEDICARE: DR. JACQUELINE LAGESON 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	06005693	OH

General Provider Information

NPI Number	:	1447486634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE LAGESON PHARMD

Provider Business Mailing Address
First Line	:	1915 CENTRAL AVE
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-4401
Country	:	US
Telephone Number	:	513-420-2546
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 CENTRAL AVE
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45044-4401
Country	:	US
Telephone Number	:	513-420-2546
Fax Number	:

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

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	06/02/2009

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