=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376895227
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW N LALUK RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2012
-----------------------------------------------------
Last Update Date | 10/02/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11475 E VIA LINDA
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85259-2638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-767-7274
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16509 E ARROYO VISTA DR
-----------------------------------------------------
City | FOUNTAIN HILLS
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85268-4476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-703-1676
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | S013319
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------