MEDICARE: THE SHORE APOTHECARIE

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	3336C0003X	Community/Retail Pharmacy	PHY462821	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5614549	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1598707135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SHORE APOTHECARIE

Provider Business Mailing Address
First Line	:	4814 E 2ND ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5312
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4814 E 2ND ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-5312
Country	:	US
Telephone Number	:	562-439-4449
Fax Number	:	562-439-4419

Authorized Official
Title or Position	:	OWNER HEAD PHARMACIST
Name	:	CYNTHIA SEWARK
Credential	:	PHARM D
Telephone Number	:	562-439-4444

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	07/10/2008

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Directions to “THE SHORE APOTHECARIE ” Practice Location

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