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NPI Code Detail

MEDICARE: JEFFREY LEDESMA BERMEJO PHARM D

MEDICARE: JEFFREY LEDESMA BERMEJO 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
1183500000XPharmacistRPH53238CA

General Provider Information

NPI Number : 1376811182
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY LEDESMA BERMEJO PHARM D
Provider Business Mailing Address
First Line : 326 E BELLBROOK ST
Second Line :
City : COVINA
State : CA
Zip : 91722-2801
Country : US
Telephone Number : 626-512-7642
Fax Number :
Provider Business Practice Location Address
First Line : 5829 LAKEWOOD BLVD
Second Line :
City : LAKEWOOD
State : CA
Zip : 90712-1001
Country : US
Telephone Number : 562-817-5690
Fax Number : 562-817-5698
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2011
Last Update Date : 12/07/2011

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