MEDICARE: DR. LAURIE ST. GERMAIN PHARMD

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	S015622	AZ

General Provider Information

NPI Number	:	1003122342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURIE ST. GERMAIN PHARMD

Provider Business Mailing Address
First Line	:	22113 S 174TH ST
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85298-8880
Country	:	US
Telephone Number	:	602-828-0035
Fax Number	:

Provider Business Practice Location Address
First Line	:	21212 E OCOTILLO RD
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-9667
Country	:	US
Telephone Number	:	480-214-9044
Fax Number	:

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

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	08/24/2010

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