MEDICARE: LISA YVONNE TREHARNE 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	56445	CA

General Provider Information

NPI Number	:	1962636431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA YVONNE TREHARNE RPH

Provider Business Mailing Address
First Line	:	18571 SOLEDAD CANYON ROAD,
Second Line	:	SAVON PHARMACY,
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91351
Country	:	US
Telephone Number	:	661-298-0233
Fax Number	:	661-298-4912

Provider Business Practice Location Address
First Line	:	18571 SOLEDAD CANYON RD
Second Line	:	SAVON PHARMACY
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91351-3700
Country	:	US
Telephone Number	:	661-298-0233
Fax Number	:	661-298-4912

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

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	05/12/2009

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