MEDICARE: DR. GINA SALVATERA HACKETT PHARMD

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	RPH 51730	CA

General Provider Information

NPI Number	:	1588953103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINA SALVATERA HACKETT PHARMD

Provider Business Mailing Address
First Line	:	1863 EVERGLADE AVE
Second Line	:
City	:	CLOVIS
State	:	CA
Zip	:	93619-2853
Country	:	US
Telephone Number	:	559-322-1545
Fax Number	:

Provider Business Practice Location Address
First Line	:	8027 N CEDAR AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-4827
Country	:	US
Telephone Number	:	559-431-1002
Fax Number	:

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

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	04/05/2011

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