MEDICARE: DR. TIMOTHY LAUGHERTY

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	PS47617	FL

General Provider Information

NPI Number	:	1225314719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY LAUGHERTY

Provider Business Mailing Address
First Line	:	120 W THATCH PALM CIR
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7174
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6820 OKEECHOBEE BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-2510
Country	:	US
Telephone Number	:	561-684-3064
Fax Number	:

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

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	10/27/2011

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