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NPI Code Detail

MEDICARE: MRS. TALI EHRLICH MAYBLUM

MEDICARE:  MRS. TALI  EHRLICH MAYBLUM
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
1183500000XPharmacist62533CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1941059121OTHERCACVS

General Provider Information

NPI Number : 1730636002
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TALI EHRLICH MAYBLUM
Provider Business Mailing Address
First Line : 1123 S CALIFORNIA BLVD
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94596-4413
Country : US
Telephone Number : 925-933-8353
Fax Number : 925-933-1935
Provider Business Practice Location Address
First Line : 1123 S CALIFORNIA BLVD
Second Line :
City : WALNUT CREEK
State : CA
Zip : 94596-4413
Country : US
Telephone Number : 925-933-8353
Fax Number : 925-933-1935
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2016
Last Update Date : 09/05/2016

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Directions to “ MRS. TALI EHRLICH MAYBLUM ” Practice Location

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