MEDICARE: DR. RICHARD ZEIDEL FOND PHARM D.

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	24232	CA

General Provider Information

NPI Number	:	1023005071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD ZEIDEL FOND PHARM D.

Provider Business Mailing Address
First Line	:	5264 BUFFALO AVE
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-5929
Country	:	US
Telephone Number	:	818-907-7046
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 S GLENOAKS BLVD
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91502-1319
Country	:	US
Telephone Number	:	818-846-9011
Fax Number	:	818-845-5342

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/08/2007

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