MEDICARE: LYNNE LAFFERTY

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	RP037572L	PA

General Provider Information

NPI Number	:	1457735177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNNE LAFFERTY

Provider Business Mailing Address
First Line	:	8 FIELDCREST DR
Second Line	:
City	:	COLLEGEVILLE
State	:	PA
Zip	:	19426-2730
Country	:	US
Telephone Number	:	610-831-2288
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 EISENHOWER AVE
Second Line	:	BUILDING B
City	:	NORRISTOWN
State	:	PA
Zip	:	19403-2331
Country	:	US
Telephone Number	:	484-690-0160
Fax Number	:	484-690-0165

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

Provider Enumeration Date	:	07/13/2015
Last Update Date	:	07/13/2015

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