MEDICARE: MRS. SUSAN LAWRENCE 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	265603-1701	UT

General Provider Information

NPI Number	:	1225250293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN LAWRENCE RPH

Provider Business Mailing Address
First Line	:	345 S 400 E
Second Line	:
City	:	HEBER
State	:	UT
Zip	:	84032
Country	:	US
Telephone Number	:	435-654-5014
Fax Number	:

Provider Business Practice Location Address
First Line	:	6545 N LANDMARK DR.
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098
Country	:	US
Telephone Number	:	435-647-9040
Fax Number	:	435-647-9042

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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