MEDICARE: WONHEE SO RPH

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	55639	CA

General Provider Information

NPI Number	:	1023222098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WONHEE SO RPH

Provider Business Mailing Address
First Line	:	291 ASPEN WAY
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93111-1816
Country	:	US
Telephone Number	:	805-964-9892
Fax Number	:	805-683-1881

Provider Business Practice Location Address
First Line	:	199 N FAIRVIEW AVE
Second Line	:
City	:	GOLETA
State	:	CA
Zip	:	93117-2304
Country	:	US
Telephone Number	:	805-964-9892
Fax Number	:	805-683-1881

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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