MEDICARE: MARY JOY BAUZON PHARMACIST

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	050828	CA

General Provider Information

NPI Number	:	1518249325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JOY BAUZON PHARMACIST

Provider Business Mailing Address
First Line	:	1430 EASTLAKE PKWY
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-1926
Country	:	US
Telephone Number	:	619-591-7042
Fax Number	:	619-591-7079

Provider Business Practice Location Address
First Line	:	1430 EASTLAKE PKWY
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91915-1926
Country	:	US
Telephone Number	:	619-591-7042
Fax Number	:	619-591-7079

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

Provider Enumeration Date	:	09/16/2011
Last Update Date	:	09/16/2011

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