MEDICARE: CHRISTIE MARIE CUSI ALCANTARA PHARMD

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	69766	CA

General Provider Information

NPI Number	:	1164881223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIE MARIE CUSI ALCANTARA PHARMD

Provider Business Mailing Address
First Line	:	701 E HARVARD ST APT 1
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1173
Country	:	US
Telephone Number	:	323-825-8338
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E HARVARD ST APT 1
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-1173
Country	:	US
Telephone Number	:	323-825-8338
Fax Number	:

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

Provider Enumeration Date	:	02/17/2016
Last Update Date	:	02/17/2016

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