MEDICARE: MR. DALE LAUER 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	15445	FL

General Provider Information

NPI Number	:	1639283401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DALE LAUER RPH

Provider Business Mailing Address
First Line	:	3200 SW 134TH TER
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33330-4650
Country	:	US
Telephone Number	:	954-475-0053
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 SW 8TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-3417
Country	:	US
Telephone Number	:	305-643-5340
Fax Number	:

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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