MEDICARE: LORIE JEAN CONTRERAS

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	S025342	AZ

General Provider Information

NPI Number	:	1942978119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORIE JEAN CONTRERAS

Provider Business Mailing Address
First Line	:	29675 N NORTH VALLEY PARKWAY
Second Line	:	1061
City	:	PHOENIX
State	:	AZ
Zip	:	85085
Country	:	US
Telephone Number	:	928-202-0631
Fax Number	:

Provider Business Practice Location Address
First Line	:	29675 N NORTH VALLEY PARKWAY
Second Line	:	1061
City	:	PHOENIX
State	:	AZ
Zip	:	85085
Country	:	US
Telephone Number	:	928-202-0631
Fax Number	:

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

Provider Enumeration Date	:	09/02/2021
Last Update Date	:	09/02/2021

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Directions to “ LORIE JEAN CONTRERAS ” Practice Location

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