MEDICARE: JEFF PACKER 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
1	183500000X	Pharmacist	27537	CA

General Provider Information

NPI Number	:	1609965193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF PACKER RPH

Provider Business Mailing Address
First Line	:	5155 RUETTE DE MER
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2832
Country	:	US
Telephone Number	:	858-755-1080
Fax Number	:	858-755-6080

Provider Business Practice Location Address
First Line	:	5155 RUETTE DE MER
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2832
Country	:	US
Telephone Number	:	858-755-1080
Fax Number	:	858-755-6080

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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Directions to “ JEFF PACKER RPH” Practice Location

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