MEDICARE: DR. MARY SHAMS 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	60505	CA

General Provider Information

NPI Number	:	1205156650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY SHAMS PHARMD

Provider Business Mailing Address
First Line	:	1159 E LOS ANGELES AVE
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-2846
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1159 E LOS ANGELES AVE
Second Line	:
City	:	SIMI VALLEY
State	:	CA
Zip	:	93065-2846
Country	:	US
Telephone Number	:	805-526-5395
Fax Number	:

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

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	06/08/2010

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