MEDICARE: ANDREA VARACALLO 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	SO15516	AZ

General Provider Information

NPI Number	:	1124350988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA VARACALLO PHARMD

Provider Business Mailing Address
First Line	:	1315 E CHANDLER BLVD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-6284
Country	:	US
Telephone Number	:	480-460-3945
Fax Number	:	480-460-3951

Provider Business Practice Location Address
First Line	:	1315 E CHANDLER BLVD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048-6284
Country	:	US
Telephone Number	:	480-460-3945
Fax Number	:	480-460-3951

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

Provider Enumeration Date	:	02/04/2010
Last Update Date	:	08/18/2015

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