MEDICARE: LAUREN ANNE DIEFENDERFER PHARM.D.

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	56326	NY

General Provider Information

NPI Number	:	1457633190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ANNE DIEFENDERFER PHARM.D.

Provider Business Mailing Address
First Line	:	37 CLIPPER CT
Second Line	:
City	:	BEAR
State	:	DE
Zip	:	19701-1687
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	585 SCHENECTADY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-1809
Country	:	US
Telephone Number	:	718-363-6726
Fax Number	:

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

Provider Enumeration Date	:	09/19/2011
Last Update Date	:	09/19/2011

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