MEDICARE: STEPHANIE TAVARES

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	79314	CA

General Provider Information

NPI Number	:	1124593116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE TAVARES

Provider Business Mailing Address
First Line	:	6639 WATT AVE
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-3607
Country	:	US
Telephone Number	:	916-332-0811
Fax Number	:

Provider Business Practice Location Address
First Line	:	6639 WATT AVE
Second Line	:
City	:	NORTH HIGHLANDS
State	:	CA
Zip	:	95660-3607
Country	:	US
Telephone Number	:	916-332-2060
Fax Number	:

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

Provider Enumeration Date	:	10/05/2018
Last Update Date	:	10/05/2018

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Directions to “ STEPHANIE TAVARES ” Practice Location

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