MEDICARE: DENISE M TRITTIN 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	115073	MN
2	183500000X	Pharmacist	12483-040	WI

General Provider Information

NPI Number	:	1740515170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE M TRITTIN RPH

Provider Business Mailing Address
First Line	:	108 4TH ST N
Second Line	:
City	:	CANNON FALLS
State	:	MN
Zip	:	55009-2036
Country	:	US
Telephone Number	:	507-263-2881
Fax Number	:	507-263-8702

Provider Business Practice Location Address
First Line	:	108 4TH ST N
Second Line	:
City	:	CANNON FALLS
State	:	MN
Zip	:	55009-2036
Country	:	US
Telephone Number	:	507-263-2881
Fax Number	:	507-263-8702

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

Provider Enumeration Date	:	10/02/2009
Last Update Date	:	10/02/2009

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