MEDICARE: JOHN HAROLD ANDERSON

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	37133	CA

General Provider Information

NPI Number	:	1720681943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN HAROLD ANDERSON

Provider Business Mailing Address
First Line	:	2374 FLORIN RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-4403
Country	:	US
Telephone Number	:	916-428-3794
Fax Number	:	916-428-0259

Provider Business Practice Location Address
First Line	:	2374 FLORIN RD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-4403
Country	:	US
Telephone Number	:	916-428-3794
Fax Number	:	916-428-0259

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

Provider Enumeration Date	:	11/19/2020
Last Update Date	:	11/19/2020

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