MEDICARE: MR. GENNADY SOSKIN PHARM.D.

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	56014	CA

General Provider Information

NPI Number	:	1427433465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GENNADY SOSKIN PHARM.D.

Provider Business Mailing Address
First Line	:	4128 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2221
Country	:	US
Telephone Number	:	714-655-5523
Fax Number	:

Provider Business Practice Location Address
First Line	:	4128 S BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2221
Country	:	US
Telephone Number	:	714-655-5523
Fax Number	:

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

Provider Enumeration Date	:	07/20/2015
Last Update Date	:	07/15/2016

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