MEDICARE: DR. GLEN L STIMMEL 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	1835P1300X	Psychiatric Pharmacist	27883	CA

General Provider Information

NPI Number	:	1245459429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN L STIMMEL PHARMD

Provider Business Mailing Address
First Line	:	USC SCHOOL OF PHARMACY
Second Line	:	1985 ZONAL AVENUE
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0001
Country	:	US
Telephone Number	:	323-442-1463
Fax Number	:	323-442-1681

Provider Business Practice Location Address
First Line	:	USC SCHOOL OF PHARMACY
Second Line	:	1985 ZONAL AVENUE
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-0001
Country	:	US
Telephone Number	:	323-442-1463
Fax Number	:	323-442-1681

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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