Healthcare Provider Details

I. General information

NPI: 1477038099
Provider Name (Legal Business Name): MICHAELA VACHUSKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 COTTAGE WAY
SACRAMENTO CA
95825-7835
US

IV. Provider business mailing address

4030 GEORGIA ST APT B
SAN DIEGO CA
92103-2610
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-5300
  • Fax:
Mailing address:
  • Phone: 916-303-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: