MEDICARE: THOMAS ALAN BORAGNO 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	35445	CA

General Provider Information

NPI Number	:	1225667132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS ALAN BORAGNO PHARM D

Provider Business Mailing Address
First Line	:	460 E 16TH ST
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-3266
Country	:	US
Telephone Number	:	949-689-7731
Fax Number	:

Provider Business Practice Location Address
First Line	:	716 E BALBOA BLVD
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92661-1306
Country	:	US
Telephone Number	:	949-673-5370
Fax Number	:

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

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	04/02/2020

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