MEDICARE: MS. PAMELA ANNE DEAN RPH

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		IL

General Provider Information

NPI Number	:	1144292657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA ANNE DEAN RPH

Provider Business Mailing Address
First Line	:	4620 DLYNN
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040
Country	:	US
Telephone Number	:	618-797-2891
Fax Number	:

Provider Business Practice Location Address
First Line	:	4620 D'LYNN DR
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040
Country	:	US
Telephone Number	:	618-797-2891
Fax Number	:

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

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	07/08/2007

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