MEDICARE: JOHN SKOVMAND

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	RPH31708	CA

General Provider Information

NPI Number	:	1588156020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN SKOVMAND

Provider Business Mailing Address
First Line	:	9554 CHAMBERLAIN ST
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93004-3074
Country	:	US
Telephone Number	:	805-279-3916
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 W HARVARD BLVD STE H
Second Line	:
City	:	SANTA PAULA
State	:	CA
Zip	:	93060-3874
Country	:	US
Telephone Number	:	805-525-3313
Fax Number	:

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

Provider Enumeration Date	:	05/31/2018
Last Update Date	:	05/31/2018

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