MEDICARE: RANAE MARIE SPORE PHARMACY TEC.

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	700468-5	MN

General Provider Information

NPI Number	:	1174528855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANAE MARIE SPORE PHARMACY TEC.

Provider Business Mailing Address
First Line	:	PO BOX 154
Second Line	:
City	:	STARBUCK
State	:	MN
Zip	:	56381-0154
Country	:	US
Telephone Number	:	320-239-2246
Fax Number	:	320-239-2296

Provider Business Practice Location Address
First Line	:	406 8 1/2 STREET
Second Line	:
City	:	STARBUCK
State	:	MN
Zip	:	56381-0154
Country	:	US
Telephone Number	:	320-239-2246
Fax Number	:	320-239-2296

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/08/2007

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