MEDICARE: MEDI-MART PHARMACY PARTNERS, LP

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	PHY46626	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHY46626	OTHER	CA	PHARMACY LICENSE NUMBER

General Provider Information

NPI Number	:	1487676383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDI-MART PHARMACY PARTNERS, LP

Provider Business Mailing Address
First Line	:	5993 LINDHURST AVE
Second Line	:
City	:	MARYSVILLE
State	:	CA
Zip	:	95901-6100
Country	:	US
Telephone Number	:	530-742-8808
Fax Number	:	530-742-8888

Provider Business Practice Location Address
First Line	:	5993 LINDHURST AVE
Second Line	:
City	:	MARYSVILLE
State	:	CA
Zip	:	95901-6100
Country	:	US
Telephone Number	:	530-742-8808
Fax Number	:	530-742-8888

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	MR. ROBERT H SHERMAN
Credential	:
Telephone Number	:	530-742-8808

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	10/09/2009

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