MEDICARE: MEDICAL CENTER PHARMACIES INC

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	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY11062	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2076783	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437287802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CENTER PHARMACIES INC

Provider Business Mailing Address
First Line	:	3137 JEFFERSON AVE
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-2959
Country	:	US
Telephone Number	:	650-366-3784
Fax Number	:	650-366-1848

Provider Business Practice Location Address
First Line	:	3137 JEFFERSON AVE
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94062-2959
Country	:	US
Telephone Number	:	650-366-3784
Fax Number	:	650-366-1848

Authorized Official
Title or Position	:	PHARMACIST/MGR
Name	:	JOHN PINGHON CHAN
Credential	:	PHARMD
Telephone Number	:	650-366-3784

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	10/06/2014

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