MEDICARE: LYNETTE M SONDROL CPHT

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	183700000X	Pharmacy Technician	351	ND

General Provider Information

NPI Number	:	1083796858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNETTE M SONDROL CPHT

Provider Business Mailing Address
First Line	:	1014 CANNON LN
Second Line	:
City	:	WASHBURN
State	:	ND
Zip	:	58577-4122
Country	:	US
Telephone Number	:	701-462-8298
Fax Number	:	701-462-3597

Provider Business Practice Location Address
First Line	:	703 MAIN AVE
Second Line	:
City	:	WASHBURN
State	:	ND
Zip	:	58577-0400
Country	:	US
Telephone Number	:	701-462-8174
Fax Number	:	701-462-3597

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/08/2007

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