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NPI Code Detail

MEDICARE: PATRICIA MAE BULOSAN ILAO PHARMD

MEDICARE: PATRICIA MAE BULOSAN ILAO 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
1183500000XPharmacist87500CA

General Provider Information

NPI Number : 1669219952
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA MAE BULOSAN ILAO PHARMD
Provider Business Mailing Address
First Line : 12025 COURSER AVE
Second Line :
City : LA MIRADA
State : CA
Zip : 90638-1420
Country : US
Telephone Number : 562-458-4989
Fax Number :
Provider Business Practice Location Address
First Line : 316 S PACIFIC COAST HWY
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-3729
Country : US
Telephone Number : 310-540-9183
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2024
Last Update Date : 08/13/2024

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Directions to “ PATRICIA MAE BULOSAN ILAO PHARMD” Practice Location

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