MEDICARE: DEBORAH W CALLICOAT C.PH.T

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	300101041152117	OH

General Provider Information

NPI Number	:	1922005453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH W CALLICOAT C.PH.T

Provider Business Mailing Address
First Line	:	704 DANBURY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-3104
Country	:	US
Telephone Number	:	513-579-3356
Fax Number	:	513-579-3400

Provider Business Practice Location Address
First Line	:	704 DANBURY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-3104
Country	:	US
Telephone Number	:	513-742-3888
Fax Number	:	860-262-9889

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/08/2007

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