MEDICARE: YOLONDA JORDAN DAMICO 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	61414	CA
2	183500000X	Pharmacist	26023025A	IN

General Provider Information

NPI Number	:	1346522166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLONDA JORDAN DAMICO PHARM. D.

Provider Business Mailing Address
First Line	:	293 ANGELITA AVE
Second Line	:
City	:	PACIFICA
State	:	CA
Zip	:	94044-3106
Country	:	US
Telephone Number	:	650-355-8061
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 PALMETTO AVE
Second Line	:
City	:	PACIFICA
State	:	CA
Zip	:	94044-1842
Country	:	US
Telephone Number	:	650-355-9901
Fax Number	:

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

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	09/16/2011

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