MEDICARE: JENNIFER LAUREN-THAMM 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	040843	NY

General Provider Information

NPI Number	:	1386976173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LAUREN-THAMM RPH

Provider Business Mailing Address
First Line	:	260 POND PATH
Second Line	:
City	:	SOUTH SETAUKET
State	:	NY
Zip	:	11720-2006
Country	:	US
Telephone Number	:	631-585-4469
Fax Number	:	631-585-4331

Provider Business Practice Location Address
First Line	:	260 POND PATH
Second Line	:
City	:	SOUTH SETAUKET
State	:	NY
Zip	:	11720-2006
Country	:	US
Telephone Number	:	631-585-4469
Fax Number	:	631-585-4331

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

Provider Enumeration Date	:	02/04/2010
Last Update Date	:	02/04/2010

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