=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932324431
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT HENRY MIGLIORI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2525 E FREMONT ST
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95205-3906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-948-0546
-----------------------------------------------------
Fax | 209-948-9307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2881 N ARATA RD
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95215-9766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-931-3982
-----------------------------------------------------
Fax | 209-948-9307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH30145
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------