Healthcare Provider Details

I. General information

NPI: 1104709179
Provider Name (Legal Business Name): MEGAN KUCHARSKI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 LIGHTWAVE AVE
SAN DIEGO CA
92123-6463
US

IV. Provider business mailing address

4964 BELLA COLLINA ST
OCEANSIDE CA
92056-1922
US

V. Phone/Fax

Practice location:
  • Phone: 858-249-4087
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberINT50328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: