MEDICARE: MR. WILLIAM DONOVAN 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	58827	CA

General Provider Information

NPI Number	:	1518388669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM DONOVAN PHARM D

Provider Business Mailing Address
First Line	:	3904 PARK BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3904 PARK BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3502
Country	:	US
Telephone Number	:	619-295-4821
Fax Number	:

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

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	12/16/2013

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