MEDICARE: MR. GEORGE RANDALL BARSAMIAN 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	35531	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	35531	OTHER	CA	BOARD OF PHARMACY CALIFORNIA

General Provider Information

NPI Number	:	1699139105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE RANDALL BARSAMIAN RPH

Provider Business Mailing Address
First Line	:	1428 CENTER AVE
Second Line	:
City	:	DOS PALOS
State	:	CA
Zip	:	93620-2320
Country	:	US
Telephone Number	:	209-392-1048
Fax Number	:

Provider Business Practice Location Address
First Line	:	1428 CENTER AVE
Second Line	:
City	:	DOS PALOS
State	:	CA
Zip	:	93620-2320
Country	:	US
Telephone Number	:	209-392-1048
Fax Number	:

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

Provider Enumeration Date	:	04/11/2016
Last Update Date	:	04/11/2016

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