MEDICARE: PROFESSIONAL PHARMACY CARE INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies	4433750001	CA
2	333600000X	Pharmacy		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053305268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL PHARMACY CARE INC.

Provider Business Mailing Address
First Line	:	811 GRAND AVE
Second Line	:	SUITE A2
City	:	SACRAMENTO
State	:	CA
Zip	:	95838-3466
Country	:	US
Telephone Number	:	916-922-4512
Fax Number	:	916-922-2540

Provider Business Practice Location Address
First Line	:	811 GRAND AVE
Second Line	:	SUITE A2
City	:	SACRAMENTO
State	:	CA
Zip	:	95838-3466
Country	:	US
Telephone Number	:	916-922-4512
Fax Number	:	916-922-2540

Authorized Official
Title or Position	:	CEO
Name	:	MRS. TERESA MOSSKELNHOFER
Credential	:
Telephone Number	:	916-922-4512

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	12/03/2007

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