MEDICARE: MISS JOANNA MALGORZATA PUSZKA 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	183500000X	Pharmacist	66272	CA

General Provider Information

NPI Number	:	1447797139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JOANNA MALGORZATA PUSZKA PHARM D

Provider Business Mailing Address
First Line	:	1043 EMERALD BAY RD
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-6210
Country	:	US
Telephone Number	:	303-621-5831
Fax Number	:

Provider Business Practice Location Address
First Line	:	1043 EMERALD BAY RD
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-6210
Country	:	US
Telephone Number	:	303-621-5831
Fax Number	:

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

Provider Enumeration Date	:	01/19/2017
Last Update Date	:	01/19/2017

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