MEDICARE: SUSAN REBEKAH ANDING 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	34194	TX

General Provider Information

NPI Number	:	1932421112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN REBEKAH ANDING RPH

Provider Business Mailing Address
First Line	:	2126 US HIGHWAY 79 S
Second Line	:
City	:	HENDERSON
State	:	TX
Zip	:	75654-4406
Country	:	US
Telephone Number	:	903-655-7561
Fax Number	:

Provider Business Practice Location Address
First Line	:	2126 US HIGHWAY 79 S
Second Line	:
City	:	HENDERSON
State	:	TX
Zip	:	75654-4406
Country	:	US
Telephone Number	:	903-655-7561
Fax Number	:

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

Provider Enumeration Date	:	02/16/2010
Last Update Date	:	02/16/2010

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