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NPI Code Detail

MEDICARE: MS. FREDI SHALITA

MEDICARE: MS. FREDI SHALITA
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
1183500000XPharmacist25436CA

General Provider Information

NPI Number : 1558648659
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. FREDI SHALITA
Provider Business Mailing Address
First Line : 78555 IRON BARK DR
Second Line :
City : PALM DESERT
State : CA
Zip : 92211-2627
Country : US
Telephone Number : 760-345-3696
Fax Number :
Provider Business Practice Location Address
First Line : 78218 VARNER RD
Second Line :
City : PALM DESERT
State : CA
Zip : 92211-4134
Country : US
Telephone Number : 760-200-4382
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2011
Last Update Date : 11/03/2011

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