MEDICARE: LAGUNA HONDA HOSPITAL 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	3336I0012X	Institutional Pharmacy
2	3336C0004X	Compounding Pharmacy
3	333600000X	Pharmacy
4	3336L0003X	Long Term Care Pharmacy	HPE4323	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1997347	OTHER		PK

General Provider Information

NPI Number	:	1255374054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAGUNA HONDA HOSPITAL PHARMACY

Provider Business Mailing Address
First Line	:	375 LAGUNA HONDA BLVD
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-1411
Country	:	US
Telephone Number	:	415-759-2300
Fax Number	:	415-759-6017

Provider Business Practice Location Address
First Line	:	375 LAGUNA HONDA BLVD
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94116-1411
Country	:	US
Telephone Number	:	415-759-2300
Fax Number	:	415-759-6017

Authorized Official
Title or Position	:	PHARMACY DIRECTOR
Name	:	MICHELLE FOUTS
Credential	:	PHARMD
Telephone Number	:	415-682-5782

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	03/31/2017

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Directions to “LAGUNA HONDA HOSPITAL PHARMACY ” Practice Location

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