MEDICARE: DEBRA WORRELL R.PH.

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	03116219	OH

General Provider Information

NPI Number	:	1093005548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA WORRELL R.PH.

Provider Business Mailing Address
First Line	:	898 S MAIN ST
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-3439
Country	:	US
Telephone Number	:	937-433-4909
Fax Number	:

Provider Business Practice Location Address
First Line	:	898 S MAIN ST
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-3439
Country	:	US
Telephone Number	:	937-433-4909
Fax Number	:

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

Provider Enumeration Date	:	04/17/2011
Last Update Date	:	04/17/2011

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