MEDICARE: LAUREN VANDERVEER 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	73969	CA
2	183500000X	Pharmacist	12731	CT

General Provider Information

NPI Number	:	1609241348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN VANDERVEER PHARMD

Provider Business Mailing Address
First Line	:	4741 ALLIED RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-2411
Country	:	US
Telephone Number	:	914-475-1710
Fax Number	:

Provider Business Practice Location Address
First Line	:	1299 BROADWAY
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92021-4902
Country	:	US
Telephone Number	:	619-441-8040
Fax Number	:	619-441-8078

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

Provider Enumeration Date	:	12/07/2015
Last Update Date	:	12/07/2015

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Directions to “ LAUREN VANDERVEER PHARMD” Practice Location

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