MEDICARE: EMILY UNDERWOOD PHARMD, LPC

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	03439364	OH
2	183500000X	Pharmacist	051.299008	IL
3	101YM0800X	Mental Health Counselor	C.2405701	OH

General Provider Information

NPI Number	:	1457720062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY UNDERWOOD PHARMD, LPC

Provider Business Mailing Address
First Line	:	1255 N FAIRFIELD RD STE 102
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2651
Country	:	US
Telephone Number	:	927-272-0187
Fax Number	:

Provider Business Practice Location Address
First Line	:	1255 N FAIRFIELD RD STE 102
Second Line	:
City	:	BEAVERCREEK
State	:	OH
Zip	:	45432-2651
Country	:	US
Telephone Number	:	618-263-2124
Fax Number	:

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

Provider Enumeration Date	:	09/24/2015
Last Update Date	:	02/24/2025

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