MEDICARE: MRS. LILIANA PACHECO CAICEDO

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	03-3-25148	OH
2	183500000X	Pharmacist	3067	PR

General Provider Information

NPI Number	:	1346221447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LILIANA PACHECO CAICEDO

Provider Business Mailing Address
First Line	:	9316 BROCK RD
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-9432
Country	:	US
Telephone Number	:	614-873-0560
Fax Number	:

Provider Business Practice Location Address
First Line	:	9316 BROCK RD
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-9432
Country	:	US
Telephone Number	:	614-873-0560
Fax Number	:

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	07/08/2007

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