MEDICARE: NORMA WANHAINEN FRASER 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	PS18289	FL

General Provider Information

NPI Number	:	1780955302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORMA WANHAINEN FRASER RPH

Provider Business Mailing Address
First Line	:	3770 TAMPA RD
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-6306
Country	:	US
Telephone Number	:	813-855-7885
Fax Number	:	813-855-5388

Provider Business Practice Location Address
First Line	:	3770 TAMPA RD
Second Line	:
City	:	OLDSMAR
State	:	FL
Zip	:	34677-6306
Country	:	US
Telephone Number	:	813-855-7885
Fax Number	:	813-855-5388

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

Provider Enumeration Date	:	01/13/2012
Last Update Date	:	01/13/2012

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