MEDICARE: LORI LEA GUYMON 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	R4351	SD

General Provider Information

NPI Number	:	1578154795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI LEA GUYMON RPH

Provider Business Mailing Address
First Line	:	1902 MT RUSHMORE RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701
Country	:	US
Telephone Number	:	605-342-0194
Fax Number	:

Provider Business Practice Location Address
First Line	:	1902 MOUNT RUSHMORE RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-4621
Country	:	US
Telephone Number	:	605-342-0194
Fax Number	:

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

Provider Enumeration Date	:	01/30/2021
Last Update Date	:	01/30/2021

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Directions to “ LORI LEA GUYMON RPH” Practice Location

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