MEDICARE: MS. ANN L YOURELL 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	11917-04	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11917-04	OTHER	WI	STATE OF WISCONSIN

General Provider Information

NPI Number	:	1326217571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANN L YOURELL RPH

Provider Business Mailing Address
First Line	:	2442 STATE RD
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54601-6155
Country	:	US
Telephone Number	:	608-775-8590
Fax Number	:	608-775-8598

Provider Business Practice Location Address
First Line	:	2442 STATE RD
Second Line	:
City	:	LA CROSSE
State	:	WI
Zip	:	54601-6155
Country	:	US
Telephone Number	:	608-775-8590
Fax Number	:	608-775-8598

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

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	02/21/2008

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