MEDICARE: MIKE'S PHARMACY, INC

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	3336C0003X	Community/Retail Pharmacy
2	333600000X	Pharmacy	PHY228790	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0578382	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295829604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIKE'S PHARMACY, INC

Provider Business Mailing Address
First Line	:	2647 INTERNATIONAL BLVD
Second Line	:	STE 106
City	:	OAKLAND
State	:	CA
Zip	:	94601-1537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2647 INTERNATIONAL BLVD
Second Line	:	STE 106
City	:	OAKLAND
State	:	CA
Zip	:	94601-1537
Country	:	US
Telephone Number	:	510-533-4130
Fax Number	:	510-533-0980

Authorized Official
Title or Position	:	CEO AND FOUNDER
Name	:	MICHAEL NATALI
Credential	:
Telephone Number	:	570-533-4130

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	02/28/2008

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Directions to “MIKE'S PHARMACY, INC ” Practice Location

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