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NPI Code Detail

MEDICARE: ELIZABETH SUSANNA PRETORIUS

MEDICARE: ELIZABETH SUSANNA PRETORIUS
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
1183500000XPharmacist56799CA

General Provider Information

NPI Number : 1013237197
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH SUSANNA PRETORIUS
Provider Business Mailing Address
First Line : 1500 NORTHGATE MALL
Second Line :
City : SAN RAFAEL
State : CA
Zip : 94903-3671
Country : US
Telephone Number : 415-492-0888
Fax Number : 415-492-0501
Provider Business Practice Location Address
First Line : 1500 NORTHGATE MALL
Second Line :
City : SAN RAFAEL
State : CA
Zip : 94903-3671
Country : US
Telephone Number : 415-492-0888
Fax Number : 415-492-0501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2010
Last Update Date : 06/11/2010

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Directions to “ ELIZABETH SUSANNA PRETORIUS ” Practice Location

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