MEDICARE: DR. MARC AWAD

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	68472	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1790783447	OTHER	CA	PHARMACY

General Provider Information

NPI Number	:	1558853127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC AWAD

Provider Business Mailing Address
First Line	:	110 W HARVARD BLVD STE H
Second Line	:
City	:	SANTA PAULA
State	:	CA
Zip	:	93060-3874
Country	:	US
Telephone Number	:	818-933-1462
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 W HARVARD BLVD STE H
Second Line	:
City	:	SANTA PAULA
State	:	CA
Zip	:	93060-3874
Country	:	US
Telephone Number	:	818-933-1462
Fax Number	:

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

Provider Enumeration Date	:	05/30/2018
Last Update Date	:	06/16/2018

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Directions to “ DR. MARC AWAD ” Practice Location

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