MEDICARE: MR. ALAN W ANDERSEN BS PHARM

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	3898	NV
2	183500000X	Pharmacist	24992	CA
3	183500000X	Pharmacist	8194	OR

General Provider Information

NPI Number	:	1992700819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALAN W ANDERSEN BS PHARM

Provider Business Mailing Address
First Line	:	PO BOX 3498
Second Line	:
City	:	INCLINE VILLAGE
State	:	NV
Zip	:	89450-3498
Country	:	US
Telephone Number	:	775-833-3060
Fax Number	:	775-831-2228

Provider Business Practice Location Address
First Line	:	898 TANAGER ST
Second Line	:	IN CARE OF VILLAGE COMPOUNDING PHARMACY
City	:	INCLINE VILLAGE
State	:	NV
Zip	:	89451
Country	:	US
Telephone Number	:	775-831-1133
Fax Number	:	775-831-2228

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	10/24/2007

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