MEDICARE: ALAN MEDOFF R.PH.

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	33088	CA

General Provider Information

NPI Number	:	1013075522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN MEDOFF R.PH.

Provider Business Mailing Address
First Line	:	7865 CEDAR LAKE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-3020
Country	:	US
Telephone Number	:	619-698-4560
Fax Number	:

Provider Business Practice Location Address
First Line	:	7865 CEDAR LAKE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-3020
Country	:	US
Telephone Number	:	619-698-4560
Fax Number	:

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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