MEDICARE: MRS. LAURIE JANE KOVARIK

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	MO044297	MO

General Provider Information

NPI Number	:	1982973798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE JANE KOVARIK

Provider Business Mailing Address
First Line	:	499 SALT LICK RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1290
Country	:	US
Telephone Number	:	636-278-3802
Fax Number	:	636-278-3808

Provider Business Practice Location Address
First Line	:	499 SALT LICK RD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1290
Country	:	US
Telephone Number	:	636-278-3802
Fax Number	:	636-278-3808

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

Provider Enumeration Date	:	12/22/2011
Last Update Date	:	12/22/2011

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