=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801391701
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EILEEN MORAN RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2018
-----------------------------------------------------
Last Update Date | 03/24/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1736 E AVENIDA DE LOS ARBOLES
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91362-1301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-493-8001
-----------------------------------------------------
Fax | 805-493-5490
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1736 E AVENIDA DE LOS ARBOLES
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91362-1301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-493-8001
-----------------------------------------------------
Fax | 805-493-5490
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 37302
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------