MEDICARE: US DEPT OF JUSTICE

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	333600000X	Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0356508	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1982933008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	US DEPT OF JUSTICE

Provider Business Mailing Address
First Line	:	9300 S WILMOT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85756-9706
Country	:	US
Telephone Number	:	520-663-5000
Fax Number	:	520-663-5146

Provider Business Practice Location Address
First Line	:	9300 S WILMOT RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85756-9706
Country	:	US
Telephone Number	:	520-663-5000
Fax Number	:	520-663-5146

Authorized Official
Title or Position	:	CHIEF PHARMACIST
Name	:	DAWN CAMPBELL
Credential	:
Telephone Number	:	520-663-5000

Provider Enumeration Date	:	12/19/2009
Last Update Date	:	02/10/2010

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Directions to “US DEPT OF JUSTICE ” Practice Location

Language	Start Address	Practice Location

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