MEDICARE: DAVID JESITUS

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	57039	CA
2	183500000X	Pharmacist	03318325	OH

General Provider Information

NPI Number	:	1205171485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID JESITUS

Provider Business Mailing Address
First Line	:	739 WALAVISTA AVENUE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94610
Country	:	US
Telephone Number	:	415-571-5123
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 WEBSTER ST STE 225
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-2376
Country	:	US
Telephone Number	:	415-923-3012
Fax Number	:

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

Provider Enumeration Date	:	11/29/2012
Last Update Date	:	11/29/2012

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Directions to “ DAVID JESITUS ” Practice Location

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