MEDICARE: AMBER ADELE LANDERS

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	8041664-1701	UT
2	183500000X	Pharmacist	2011024500	MO
3	183500000X	Pharmacist	74560	CA

General Provider Information

NPI Number	:	1255878757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER ADELE LANDERS

Provider Business Mailing Address
First Line	:	245 CHENERY ST
Second Line	:	APT 1
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-2759
Country	:	US
Telephone Number	:	417-773-7376
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 CHENERY ST
Second Line	:	APT 1
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94131-2759
Country	:	US
Telephone Number	:	417-773-7376
Fax Number	:

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

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	01/23/2017

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Directions to “ AMBER ADELE LANDERS ” Practice Location

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