MEDICARE: MRS. AMY LOUISE CORY 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	116119-7	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	116119-7	OTHER	MN	PHARMACY LICENSE

General Provider Information

NPI Number	:	1902980238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY LOUISE CORY RPH

Provider Business Mailing Address
First Line	:	21386 KLAR JO RD
Second Line	:
City	:	CLITHERALL
State	:	MN
Zip	:	56524-9500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 LAKE AVE N
Second Line	:
City	:	BATTLE LAKE
State	:	MN
Zip	:	56515-0538
Country	:	US
Telephone Number	:	218-864-5261
Fax Number	:	218-864-8178

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	09/12/2007

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