MEDICARE: MR. DONALD I WEBSTER 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	26016791A	IN

General Provider Information

NPI Number	:	1376829853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DONALD I WEBSTER RPH

Provider Business Mailing Address
First Line	:	6905 KENNEDY AVE
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46323-2210
Country	:	US
Telephone Number	:	219-844-5034
Fax Number	:

Provider Business Practice Location Address
First Line	:	6905 KENNEDY AVE
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46323-2210
Country	:	US
Telephone Number	:	219-844-5034
Fax Number	:

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

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	10/27/2011

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