=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669764460
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LORENA DE AUSEN PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2011
-----------------------------------------------------
Last Update Date | 03/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 JARRETT WHITE RD TRIPLER ARMY MEDICAL CENTER
-----------------------------------------------------
City | TRIPLER ARMY MEDICAL CENTER
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96859-5001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-371-7789
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 JARRETT WHITE RD TRIPLER ARMY MEDICAL CENTER
-----------------------------------------------------
City | TRIPLER ARMY MEDICAL CENTER
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96859-5001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | 19797
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------