MEDICARE: JEANNE SILL 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	RP000004624	NM

General Provider Information

NPI Number	:	1891000238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE SILL RPH

Provider Business Mailing Address
First Line	:	2700 W PICACHO AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-8721
Country	:	US
Telephone Number	:	575-523-0833
Fax Number	:	575-523-1489

Provider Business Practice Location Address
First Line	:	2700 W PICACHO AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-8721
Country	:	US
Telephone Number	:	575-523-0833
Fax Number	:	575-523-1489

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

Provider Enumeration Date	:	08/10/2010
Last Update Date	:	08/10/2010

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