MEDICARE: MRS. MARGUERITE SHAY 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	RPH58625	CA

General Provider Information

NPI Number	:	1316229768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARGUERITE SHAY PHARM D.

Provider Business Mailing Address
First Line	:	PO BOX 10413
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91510-0413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 W MAGNOLIA BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-3030
Country	:	US
Telephone Number	:	818-841-1685
Fax Number	:

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

Provider Enumeration Date	:	09/12/2011
Last Update Date	:	09/12/2011

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