MEDICARE: MARK ABOUCHABKI

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	56901	CA

General Provider Information

NPI Number	:	1073938791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ABOUCHABKI

Provider Business Mailing Address
First Line	:	12998 DEER CANYON CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-4218
Country	:	US
Telephone Number	:	858-220-5081
Fax Number	:	619-222-5879

Provider Business Practice Location Address
First Line	:	3345 SPORTS ARENA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-4567
Country	:	US
Telephone Number	:	619-222-5818
Fax Number	:	619-222-5879

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

Provider Enumeration Date	:	03/04/2014
Last Update Date	:	03/04/2014

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