MEDICARE: MARK PAUL BESEDA PHARMACIST

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	33386	CA

General Provider Information

NPI Number	:	1417933466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK PAUL BESEDA PHARMACIST

Provider Business Mailing Address
First Line	:	3025 OLD RANCH CIR
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95209-4841
Country	:	US
Telephone Number	:	209-477-7262
Fax Number	:

Provider Business Practice Location Address
First Line	:	3233 W HAMMER LN
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95209-2751
Country	:	US
Telephone Number	:	209-952-1212
Fax Number	:	209-952-1232

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

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	07/08/2007

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