MEDICARE: DR. ANNA STAUDT RPH, 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	03236834	OH

General Provider Information

NPI Number	:	1194225987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA STAUDT RPH, PHARMD

Provider Business Mailing Address
First Line	:	251 N MAIN ST
Second Line	:
City	:	CEDARVILLE
State	:	OH
Zip	:	45314-8501
Country	:	US
Telephone Number	:	419-571-8691
Fax Number	:

Provider Business Practice Location Address
First Line	:	882 S HAMILTON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-3003
Country	:	US
Telephone Number	:	614-235-5555
Fax Number	:

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

Provider Enumeration Date	:	02/18/2018
Last Update Date	:	07/23/2019

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