MEDICARE: KAYCEE KEALOHA LOKELANI SAN AGUSTIN-NORDMEIER PHARMD

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	85616	CA

General Provider Information

NPI Number	:	1134885379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYCEE KEALOHA LOKELANI SAN AGUSTIN-NORDMEIER PHARMD

Provider Business Mailing Address
First Line	:	870 ORKNEY AVE
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95054-2251
Country	:	US
Telephone Number	:	808-346-0493
Fax Number	:

Provider Business Practice Location Address
First Line	:	1757 W SAN CARLOS ST
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-5222
Country	:	US
Telephone Number	:	408-878-0112
Fax Number	:

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

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	11/11/2021

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