MEDICARE: DR. PAUL WILLIAM LOFHOLM 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	23701	CA

General Provider Information

NPI Number	:	1154314037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL WILLIAM LOFHOLM PHARM.D.

Provider Business Mailing Address
First Line	:	560 RALSTON LN
Second Line	:
City	:	NEWCASTLE
State	:	CA
Zip	:	95658-9603
Country	:	US
Telephone Number	:	415-845-6160
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 FRANCISCO BLVD E
Second Line	:	#1
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-5539
Country	:	US
Telephone Number	:	415-924-2480
Fax Number	:	415-924-1015

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

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	11/25/2013

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