MEDICARE: MS. SHIRLEY PAULINE PEER 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	14769	AZ
2	183500000X	Pharmacist	012353	KY
3	183500000X	Pharmacist	PS37325 25689	FL

General Provider Information

NPI Number	:	1255496535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHIRLEY PAULINE PEER RPH

Provider Business Mailing Address
First Line	:	2113 ROY ROGERS WAY
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86409
Country	:	US
Telephone Number	:	928-692-1312
Fax Number	:

Provider Business Practice Location Address
First Line	:	4747 S HIGHWAY 95
Second Line	:	SMITH'S FOOD AND DRUG STORES LTD
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9377
Country	:	US
Telephone Number	:	928-330-3704
Fax Number	:	928-330-3707

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

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	02/25/2008

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