MEDICARE: ANDREA D NISHIMOTO-MACEDO

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	9072263-1701	UT

General Provider Information

NPI Number	:	1750999371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA D NISHIMOTO-MACEDO

Provider Business Mailing Address
First Line	:	8243 WESTMORE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-2218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8243 WESTMORE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-2218
Country	:	US
Telephone Number	:	417-818-3883
Fax Number	:

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

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	07/20/2020

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