MEDICARE: DR. LEA TUDOR 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	26264	NC

General Provider Information

NPI Number	:	1003342643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEA TUDOR PHARMD

Provider Business Mailing Address
First Line	:	940 US 64 HWY W
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27523-7184
Country	:	US
Telephone Number	:	919-380-1443
Fax Number	:	919-380-9822

Provider Business Practice Location Address
First Line	:	940 US 64 HWY W
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27523-7184
Country	:	US
Telephone Number	:	919-380-1443
Fax Number	:	919-380-9822

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

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	05/02/2017

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