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NPI Code Detail

MEDICARE: MR. ALFRED MICHAEL FAGUNDES RPH

MEDICARE: MR. ALFRED MICHAEL FAGUNDES RPH
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
1183500000XPharmacist24038CA
2183500000XPharmacist9086OR
3183500000XPharmacist2111HI

General Provider Information

NPI Number : 1568429736
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ALFRED MICHAEL FAGUNDES RPH
Provider Business Mailing Address
First Line : 125 PINE VIEW CT
Second Line : P.O. BOX 2123
City : CRESCENT CITY
State : CA
Zip : 95531-9167
Country : US
Telephone Number : 707-464-8449
Fax Number :
Provider Business Practice Location Address
First Line : 475 M ST
Second Line :
City : CRESCENT CITY
State : CA
Zip : 95531-4129
Country : US
Telephone Number : 707-465-3663
Fax Number : 707-464-8533
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2006
Last Update Date : 07/08/2007

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