MEDICARE: MS. SABRINA MARIE MCQUEEN PHARM.D.

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	54629	CA

General Provider Information

NPI Number	:	1235439993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SABRINA MARIE MCQUEEN PHARM.D.

Provider Business Mailing Address
First Line	:	PO BOX 785
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-0785
Country	:	US
Telephone Number	:	415-269-3707
Fax Number	:	510-658-2552

Provider Business Practice Location Address
First Line	:	5130 BROADWAY
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-4620
Country	:	US
Telephone Number	:	510-658-5693
Fax Number	:	510-658-2552

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

Provider Enumeration Date	:	10/28/2010
Last Update Date	:	10/28/2010

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