MEDICARE: DR. BERNARD GRAMLICH 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	53112	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY55594	OTHER	CA	PHARMACY LICENSE

General Provider Information

NPI Number	:	1124009246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNARD GRAMLICH PHARM.D.

Provider Business Mailing Address
First Line	:	PO BOX 9227
Second Line	:
City	:	RANCHO SANTA FE
State	:	CA
Zip	:	92067-4227
Country	:	US
Telephone Number	:	858-759-6625
Fax Number	:	858-759-6729

Provider Business Practice Location Address
First Line	:	16089 SAN DIEGUITO ROAD H 102/9227
Second Line	:
City	:	RANCHO SANTA FE
State	:	CA
Zip	:	92067-9206
Country	:	US
Telephone Number	:	858-759-6625
Fax Number	:	858-759-6927

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	02/17/2022

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