MEDICARE: MRS. VANESSA MARIA PRATT

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	050077	NY
2	183500000X	Pharmacist	17589	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932385861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANESSA MARIA PRATT

Provider Business Mailing Address
First Line	:	12216 N NC HIGHWAY 150
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-9730
Country	:	US
Telephone Number	:	518-764-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	12216 N NC HIGHWAY 150
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-9730
Country	:	US
Telephone Number	:	518-764-2211
Fax Number	:

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

Provider Enumeration Date	:	01/09/2008
Last Update Date	:	03/15/2011

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Directions to “ MRS. VANESSA MARIA PRATT ” Practice Location

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