MEDICARE: MS. ANTOINETTE C BECZAK-MASON RPH

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	PU36157	CA

General Provider Information

NPI Number	:	1831418433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANTOINETTE C BECZAK-MASON RPH

Provider Business Mailing Address
First Line	:	118 THOMAS CT
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-4809
Country	:	US
Telephone Number	:	916-983-7304
Fax Number	:

Provider Business Practice Location Address
First Line	:	5409 SUNRISE BLVD
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-7806
Country	:	US
Telephone Number	:	916-961-2064
Fax Number	:

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

Provider Enumeration Date	:	05/20/2010
Last Update Date	:	05/20/2010

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