MEDICARE: MR. EUGENE FRANCIS DEDONDER R.PH.

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	10104	KS

General Provider Information

NPI Number	:	1376528604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EUGENE FRANCIS DEDONDER R.PH.

Provider Business Mailing Address
First Line	:	649 ROAD 200
Second Line	:
City	:	EMPORIA
State	:	KS
Zip	:	66801-7603
Country	:	US
Telephone Number	:	620-343-6800
Fax Number	:	620-341-7836

Provider Business Practice Location Address
First Line	:	1201 W 12TH AVE
Second Line	:
City	:	EMPORIA
State	:	KS
Zip	:	66801-2504
Country	:	US
Telephone Number	:	620-343-6800
Fax Number	:	620-341-7836

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

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/08/2007

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