MEDICARE: FAIRUZ AFRAM RPH.

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	68611	CA
2	183500000X	Pharmacist	19256	MD

General Provider Information

NPI Number	:	1215369525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAIRUZ AFRAM RPH.

Provider Business Mailing Address
First Line	:	2300 IRON POINT RD
Second Line	:	APT. 911
City	:	FOLSOM
State	:	CA
Zip	:	95630-8489
Country	:	US
Telephone Number	:	443-854-8523
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 IRON POINT RD
Second Line	:	APT. 911
City	:	FOLSOM
State	:	CA
Zip	:	95630-8489
Country	:	US
Telephone Number	:	443-854-8523
Fax Number	:

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

Provider Enumeration Date	:	08/09/2013
Last Update Date	:	08/09/2013

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