MEDICARE: LAURA JEAN GIFFORD RPH, CF

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	PH00018768	WA

General Provider Information

NPI Number	:	1841294303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA JEAN GIFFORD RPH, CF

Provider Business Mailing Address
First Line	:	20608 6TH PL W
Second Line	:
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-7262
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7320 216TH ST SW
Second Line	:	STE 100
City	:	EDMONDS
State	:	WA
Zip	:	98026-8006
Country	:	US
Telephone Number	:	425-673-3700
Fax Number	:	425-673-3717

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/08/2007

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