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NPI Code Detail

MEDICARE: MELINDA INDRAJANI WIDJAJA PHARM D

MEDICARE: MELINDA INDRAJANI WIDJAJA 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
1183500000XPharmacistRPH57142CA

General Provider Information

NPI Number : 1487740528
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELINDA INDRAJANI WIDJAJA PHARM D
Provider Business Mailing Address
First Line : 1550 GATEWAY BLVD
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6901
Country : US
Telephone Number : 707-427-4524
Fax Number :
Provider Business Practice Location Address
First Line : 1550 GATEWAY BLVD
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6901
Country : US
Telephone Number : 707-427-4524
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 07/08/2007

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Directions to “ MELINDA INDRAJANI WIDJAJA PHARM D” Practice Location

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