MEDICARE: EZSTEP INC

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	039428	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PHY46999	OTHER	CA	PHARMACY PERMIT NUMBER

General Provider Information

NPI Number	:	1629105549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EZSTEP INC

Provider Business Mailing Address
First Line	:	1460 TULLY RD
Second Line	:	604
City	:	SAN JOSE
State	:	CA
Zip	:	95122-3059
Country	:	US
Telephone Number	:	408-277-0562
Fax Number	:	408-277-0592

Provider Business Practice Location Address
First Line	:	1460 TULLY RD
Second Line	:	604
City	:	SAN JOSE
State	:	CA
Zip	:	95122-3059
Country	:	US
Telephone Number	:	408-277-0562
Fax Number	:	408-277-0592

Authorized Official
Title or Position	:	CEO OWNER
Name	:	DR. EDWARD G KLUJ
Credential	:	PHARM D
Telephone Number	:	408-277-0562

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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Directions to “EZSTEP INC ” Practice Location

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