MEDICARE: DR. JOSEPH M FILLY PHARMACIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	80881	CA

General Provider Information

NPI Number	:	1003453192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH M FILLY PHARMACIST

Provider Business Mailing Address
First Line	:	1301 E 17TH ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-8503
Country	:	US
Telephone Number	:	714-541-1747
Fax Number	:	714-541-2226

Provider Business Practice Location Address
First Line	:	1301 E 17TH ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-8503
Country	:	US
Telephone Number	:	714-541-1747
Fax Number	:	714-541-2226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2019
Last Update Date	:	12/08/2019

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