MEDICARE: MARYAM FATOHA

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	77859	CA

General Provider Information

NPI Number	:	1396222477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYAM FATOHA

Provider Business Mailing Address
First Line	:	572 FLETCHER PKWY
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-2509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	572 FLETCHER PKWY
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92020-2509
Country	:	US
Telephone Number	:	619-440-3701
Fax Number	:

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

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	07/23/2018

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Directions to “ MARYAM FATOHA ” Practice Location

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