Healthcare Provider Details

I. General information

NPI: 1083240048
Provider Name (Legal Business Name): MICHAEL ANTHONY ABRAM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 BECK RD
LOMPOC CA
93436-8301
US

IV. Provider business mailing address

1071 FAIR OAKS AVE
ARROYO GRANDE CA
93420-3822
US

V. Phone/Fax

Practice location:
  • Phone: 805-570-7143
  • Fax:
Mailing address:
  • Phone: 805-570-7143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number64451
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number64451
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number64451
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: