MEDICARE: MRS. REBECCA LOFHOLM

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	33497	CA

General Provider Information

NPI Number	:	1013141340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA LOFHOLM

Provider Business Mailing Address
First Line	:	2 BON AIR RD STE 130
Second Line	:
City	:	LARKSPUR
State	:	CA
Zip	:	94939-1142
Country	:	US
Telephone Number	:	415-924-2454
Fax Number	:	415-924-1015

Provider Business Practice Location Address
First Line	:	2 BON AIR RD STE 130
Second Line	:
City	:	LARKSPUR
State	:	CA
Zip	:	94939-1142
Country	:	US
Telephone Number	:	415-924-2454
Fax Number	:	415-924-1015

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

Provider Enumeration Date	:	05/14/2009
Last Update Date	:	05/14/2009

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