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NPI Code Detail

MEDICARE: MISS MYRA MAGTIBAY FAJILAN

MEDICARE: MISS MYRA MAGTIBAY FAJILAN
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
1183500000XPharmacist65125CA

General Provider Information

NPI Number : 1710275300
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS MYRA MAGTIBAY FAJILAN
Provider Business Mailing Address
First Line : 9737 SAGE THRASHER CIR
Second Line :
City : ELK GROVE
State : CA
Zip : 95757-8125
Country : US
Telephone Number : 530-550-1080
Fax Number :
Provider Business Practice Location Address
First Line : 8368 ELK GROVE FLORIN RD
Second Line :
City : SACRAMENTO
State : CA
Zip : 95829-9228
Country : US
Telephone Number : 916-681-3558
Fax Number : 916-681-2893
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2011
Last Update Date : 07/15/2011

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Directions to “ MISS MYRA MAGTIBAY FAJILAN ” Practice Location

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