MEDICARE: TIFFANY WU

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	72056	CA

General Provider Information

NPI Number	:	1669752663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY WU

Provider Business Mailing Address
First Line	:	30019 HAWTHORNE BLVD
Second Line	:
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-5434
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30019 HAWTHORNE BLVD
Second Line	:
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-5434
Country	:	US
Telephone Number	:	310-377-6829
Fax Number	:

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

Provider Enumeration Date	:	08/22/2011
Last Update Date	:	04/12/2015

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Directions to “ TIFFANY WU ” Practice Location

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