MEDICARE: MRS. LAURA ALLEN 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	5302036726	MI

General Provider Information

NPI Number	:	1942474390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA ALLEN RPH

Provider Business Mailing Address
First Line	:	860 N VAN DYKE RD
Second Line	:
City	:	ALMONT
State	:	MI
Zip	:	48003-8502
Country	:	US
Telephone Number	:	810-798-8501
Fax Number	:	810-798-3303

Provider Business Practice Location Address
First Line	:	860 N VAN DYKE RD
Second Line	:
City	:	ALMONT
State	:	MI
Zip	:	48003-8502
Country	:	US
Telephone Number	:	810-798-8501
Fax Number	:	810-798-3303

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

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	04/16/2008

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