MEDICARE: ALISON MATTHIAS NILES

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	60099	CA

General Provider Information

NPI Number	:	1356641427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON MATTHIAS NILES

Provider Business Mailing Address
First Line	:	3610 ADAMS AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-2212
Country	:	US
Telephone Number	:	619-280-5514
Fax Number	:	619-280-4975

Provider Business Practice Location Address
First Line	:	3610 ADAMS AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-2212
Country	:	US
Telephone Number	:	619-280-5514
Fax Number	:	619-280-4975

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

Provider Enumeration Date	:	10/23/2010
Last Update Date	:	07/06/2013

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