MEDICARE: MS. EDWINA MARLENE LANHAM 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	S10873	AZ
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	20272	NC

General Provider Information

NPI Number	:	1841537610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EDWINA MARLENE LANHAM RPH

Provider Business Mailing Address
First Line	:	6602 E PHELPS RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-5659
Country	:	US
Telephone Number	:	480-991-0962
Fax Number	:

Provider Business Practice Location Address
First Line	:	6602 E PHELPS RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-5659
Country	:	US
Telephone Number	:	480-991-0962
Fax Number	:

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

Provider Enumeration Date	:	01/13/2013
Last Update Date	:	01/13/2013

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