MEDICARE: SYEDA JUMANA RPH

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	S016331	AZ

General Provider Information

NPI Number	:	1366799017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYEDA JUMANA RPH

Provider Business Mailing Address
First Line	:	5110 S POWER RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-4201
Country	:	US
Telephone Number	:	480-281-0269
Fax Number	:	480-178-2882

Provider Business Practice Location Address
First Line	:	5110 S POWER RD
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-4201
Country	:	US
Telephone Number	:	480-281-0269
Fax Number	:	480-178-2882

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

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	08/13/2012

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