MEDICARE: PATRICK LEO SCANLON 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	42057	CA

General Provider Information

NPI Number	:	1942570411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK LEO SCANLON RPH

Provider Business Mailing Address
First Line	:	11418 VIA SANTA BRISA
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-4260
Country	:	US
Telephone Number	:	760-473-7105
Fax Number	:

Provider Business Practice Location Address
First Line	:	8251 MIRA MESA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-2603
Country	:	US
Telephone Number	:	858-357-2003
Fax Number	:

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

Provider Enumeration Date	:	12/30/2011
Last Update Date	:	12/30/2011

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