MEDICARE: ANDREA LYNN RATLIFF 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	2015020755	MO

General Provider Information

NPI Number	:	1184100281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA LYNN RATLIFF RPH

Provider Business Mailing Address
First Line	:	2073 WASHINGTON XING
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-5285
Country	:	US
Telephone Number	:	636-239-4120
Fax Number	:	636-239-4125

Provider Business Practice Location Address
First Line	:	2073 WASHINGTON XING
Second Line	:
City	:	WASHINGTON
State	:	MO
Zip	:	63090-5285
Country	:	US
Telephone Number	:	636-239-4120
Fax Number	:	636-239-4125

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

Provider Enumeration Date	:	07/12/2018
Last Update Date	:	07/12/2018

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