MEDICARE: RONALD ANDERSON

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	7438	NE
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	13400	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13400	OTHER	IA	IOWA PHARMACIST LICENSE
2	7438	OTHER	NE	NEBRASKA PHARMACIST LICENSE

General Provider Information

NPI Number	:	1184989097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD ANDERSON

Provider Business Mailing Address
First Line	:	1157 COUNTY ROAD R
Second Line	:
City	:	NORTH BEND
State	:	NE
Zip	:	68649-2022
Country	:	US
Telephone Number	:	402-652-8114
Fax Number	:

Provider Business Practice Location Address
First Line	:	1157 COUNTY ROAD R
Second Line	:
City	:	NORTH BEND
State	:	NE
Zip	:	68649-2022
Country	:	US
Telephone Number	:	402-652-8114
Fax Number	:

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

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	07/06/2012

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Directions to “ RONALD ANDERSON ” Practice Location

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