MEDICARE: DR. NICOLE TAMIKO MASADA PEPE 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	81105	CA

General Provider Information

NPI Number	:	1346887361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE TAMIKO MASADA PEPE PHARMD

Provider Business Mailing Address
First Line	:	13128 PSOMAS WAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-2215
Country	:	US
Telephone Number	:	206-366-5808
Fax Number	:

Provider Business Practice Location Address
First Line	:	13128 PSOMAS WAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-2215
Country	:	US
Telephone Number	:	206-366-5808
Fax Number	:

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

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	12/09/2019

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