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General NPI Number Information
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NPI Number | 1629151956
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Entity Type | Organization
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Legal Business Name | LAFAYETTE COLLEGE
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 607 HIGH ST
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City | EASTON
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State | PA
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Zip | 18042-7641
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Country | US
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Telephone | 610-330-5001
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Fax | 610-330-5704
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Provider Business Mailing Address
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Address Line | 607 HIGH ST
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City | EASTON
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State | PA
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Zip | 18042-7641
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Country | US
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Telephone | 610-330-5001
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Fax | 610-330-5704
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Authorized Official
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Title or Position | MANAGED CARE SPECIALIST
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Name | DIRENDIA SHACKELFORD
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Credential |
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Telephone | 800-654-0889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | MD045009E
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License Number State | PA
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