MEDICARE: MRS. CHARMAINE LESLEY MOLLER BACHELOR OF PHARMACY

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	58282	CA

General Provider Information

NPI Number	:	1215243308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARMAINE LESLEY MOLLER BACHELOR OF PHARMACY

Provider Business Mailing Address
First Line	:	420 GRASS VALLEY HWY
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95603-3714
Country	:	US
Telephone Number	:	530-885-9381
Fax Number	:	530-823-8653

Provider Business Practice Location Address
First Line	:	420 GRASS VALLEY HWY
Second Line	:
City	:	AUBURN
State	:	CA
Zip	:	95603-3714
Country	:	US
Telephone Number	:	530-885-9381
Fax Number	:	530-823-8653

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

Provider Enumeration Date	:	08/26/2010
Last Update Date	:	08/26/2010

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