MEDICARE: SAMANTHAJO ANNE TRUDE

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	183700000X	Pharmacy Technician	PT26352	MA

General Provider Information

NPI Number	:	1750976023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHAJO ANNE TRUDE

Provider Business Mailing Address
First Line	:	240 AVENUE A
Second Line	:
City	:	TURNERS FALLS
State	:	MA
Zip	:	01376-1817
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 AVENUE A
Second Line	:
City	:	TURNERS FALLS
State	:	MA
Zip	:	01376-1817
Country	:	US
Telephone Number	:	413-863-3107
Fax Number	:

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

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	03/08/2021

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