MEDICARE: BRIGITTE OUABO

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	74974	CA

General Provider Information

NPI Number	:	1376085274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIGITTE OUABO

Provider Business Mailing Address
First Line	:	1525 FRANCISCO BLVD E
Second Line	:	2
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-5539
Country	:	US
Telephone Number	:	415-455-9042
Fax Number	:	415-455-9318

Provider Business Practice Location Address
First Line	:	1525 FRANCISCO BLVD E
Second Line	:	2
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-5539
Country	:	US
Telephone Number	:	415-455-9042
Fax Number	:	415-455-9318

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

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	11/08/2016

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Directions to “ BRIGITTE OUABO ” Practice Location

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