MEDICARE: PILLCO PHARMACY

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	26125	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	:	1073514303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PILLCO PHARMACY

Provider Business Mailing Address
First Line	:	2939 ALTA VIEW DR
Second Line	:	SUITE L
City	:	SAN DIEGO
State	:	CA
Zip	:	92139-3394
Country	:	US
Telephone Number	:	619-470-4550
Fax Number	:	619-470-6709

Provider Business Practice Location Address
First Line	:	2939 ALTA VIEW DR
Second Line	:	SUITE L
City	:	SAN DIEGO
State	:	CA
Zip	:	92139-3394
Country	:	US
Telephone Number	:	619-470-4550
Fax Number	:	619-470-6709

Authorized Official
Title or Position	:	OWNER/PHARCIST
Name	:	MR. WILLIAM PAUL MASCARI
Credential	:	PHARM.D.
Telephone Number	:	619-470-4550

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/22/2020

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Directions to “PILLCO PHARMACY ” Practice Location

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