MEDICARE: LYNDA UR-STEVENS

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	28RI01583800	NJ
2	183500000X	Pharmacist	PS19595	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PS19595	OTHER	FL	RPH STATE LICENSE
2	28RI01583800	OTHER	NJ	RPH STATE LICENSE

General Provider Information

NPI Number	:	1932377520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNDA UR-STEVENS

Provider Business Mailing Address
First Line	:	1144 LONGBOAT AVE
Second Line	:
City	:	BEACHWOOD
State	:	NJ
Zip	:	08722-4404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4578 ROUTE 9 S
Second Line	:
City	:	HOWELL
State	:	NJ
Zip	:	07731-3771
Country	:	US
Telephone Number	:	732-364-3700
Fax Number	:

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

Provider Enumeration Date	:	02/15/2008
Last Update Date	:	02/15/2008

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Directions to “ LYNDA UR-STEVENS ” Practice Location

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