MEDICARE: MR. ROMEO GONZALES BUISON

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	RPH44829	CA

General Provider Information

NPI Number	:	1477712727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROMEO GONZALES BUISON

Provider Business Mailing Address
First Line	:	234 S FELDNER RD
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-2716
Country	:	US
Telephone Number	:	714-634-8780
Fax Number	:	714-634-8780

Provider Business Practice Location Address
First Line	:	490 S MAIN ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-4806
Country	:	US
Telephone Number	:	707-694-1845
Fax Number	:

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

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	06/03/2008

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