MEDICARE: DR. ANDREW PHILLIP TRAYNOR PHARM.D.

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	118007-1	MN

General Provider Information

NPI Number	:	1962409441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW PHILLIP TRAYNOR PHARM.D.

Provider Business Mailing Address
First Line	:	1207 JEAN MARIE ST
Second Line	:
City	:	CLOQUET
State	:	MN
Zip	:	55720-3004
Country	:	US
Telephone Number	:	218-879-6309
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 KIRBY DR
Second Line	:	215 LIFE SCIENCE
City	:	DULUTH
State	:	MN
Zip	:	55812-3003
Country	:	US
Telephone Number	:	218-726-6027
Fax Number	:

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	08/29/2007

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