MEDICARE: MISS ALICESON ALENA POWELL

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	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1932215670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ALICESON ALENA POWELL

Provider Business Mailing Address
First Line	:	RR 1 BOX 75
Second Line	:
City	:	SAINT GEORGE
State	:	GA
Zip	:	31562-9706
Country	:	US
Telephone Number	:	912-843-2010
Fax Number	:

Provider Business Practice Location Address
First Line	:	RR 1 BOX 75
Second Line	:
City	:	SAINT GEORGE
State	:	GA
Zip	:	31562-9706
Country	:	US
Telephone Number	:	912-843-2010
Fax Number	:

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	07/08/2007

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