MEDICARE: MRS. SADIE KARIMI MOSHTAGHI PHARMACY TECHNICIAN

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	183700000X	Pharmacy Technician	75703	CA

General Provider Information

NPI Number	:	1417242686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SADIE KARIMI MOSHTAGHI PHARMACY TECHNICIAN

Provider Business Mailing Address
First Line	:	PO BOX 81735
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92138-1735
Country	:	US
Telephone Number	:	619-813-0458
Fax Number	:

Provider Business Practice Location Address
First Line	:	5923 BALBOA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-2711
Country	:	US
Telephone Number	:	619-813-0458
Fax Number	:

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

Provider Enumeration Date	:	06/15/2011
Last Update Date	:	06/15/2011

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