MEDICARE: MRS. LAUREN MARY LEO 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	0005749	CT

General Provider Information

NPI Number	:	1558644260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN MARY LEO RPH

Provider Business Mailing Address
First Line	:	10 COLONIAL DR
Second Line	:
City	:	CLINTON
State	:	CT
Zip	:	06413-2510
Country	:	US
Telephone Number	:	860-391-1096
Fax Number	:	860-664-1632

Provider Business Practice Location Address
First Line	:	10 COLONIAL DR
Second Line	:
City	:	CLINTON
State	:	CT
Zip	:	06413-2510
Country	:	US
Telephone Number	:	860-391-1096
Fax Number	:	860-664-1632

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

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	09/20/2011

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