MEDICARE: DR. JAMES THAN SOE 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	85349	CA

General Provider Information

NPI Number	:	1215609375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES THAN SOE PHARMD

Provider Business Mailing Address
First Line	:	1100 VAN NESS AVE STE C
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-6979
Country	:	US
Telephone Number	:	415-783-1909
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 VAN NESS AVE STE C
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-6979
Country	:	US
Telephone Number	:	415-783-1909
Fax Number	:

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

Provider Enumeration Date	:	09/28/2021
Last Update Date	:	09/28/2021

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