MEDICARE: MEDICIUS.COM.INC

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	4374	AZ

General Provider Information

NPI Number	:	1588643514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICIUS.COM.INC

Provider Business Mailing Address
First Line	:	19401 N CAVE CREEK RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024-1827
Country	:	US
Telephone Number	:	805-446-1973
Fax Number	:

Provider Business Practice Location Address
First Line	:	19401 N CAVE CREEK RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85024
Country	:	US
Telephone Number	:	805-446-1973
Fax Number	:

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MR. NATHAN KAPLAN
Credential	:
Telephone Number	:	805-446-1973

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	08/22/2020

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