MEDICARE: YOUSIF KATTOULA 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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	044470	CA

General Provider Information

NPI Number	:	1326418419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOUSIF KATTOULA PHARM.D.

Provider Business Mailing Address
First Line	:	2650 JAMACHA RD STE 147
Second Line	:	PMB # 111
City	:	EL CAJON
State	:	CA
Zip	:	92019-4319
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 JAMACHA RD STE 147
Second Line	:	PMB # 111
City	:	EL CAJON
State	:	CA
Zip	:	92019-4319
Country	:	US
Telephone Number	:	619-933-4092
Fax Number	:

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

Provider Enumeration Date	:	10/01/2015
Last Update Date	:	10/01/2015

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