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NPI Code Detail

MEDICARE: ROGER LASTINE

MEDICARE: ROGER LASTINE
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
1183500000XPharmacistS010488AZ

General Provider Information

NPI Number : 1235551664
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER LASTINE
Provider Business Mailing Address
First Line : 1955 N ALANDALE AVE
Second Line :
City : TUCSON
State : AZ
Zip : 85715-4554
Country : US
Telephone Number : 520-290-6633
Fax Number :
Provider Business Practice Location Address
First Line : 7150 E SPEEDWAY BLVD
Second Line :
City : TUCSON
State : AZ
Zip : 85710-1318
Country : US
Telephone Number : 520-722-8669
Fax Number : 520-722-0281
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2014
Last Update Date : 01/21/2014

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Directions to “ ROGER LASTINE ” Practice Location

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