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NPI Code Detail

MEDICARE: JUSTIN WASCHAK

MEDICARE: JUSTIN WASCHAK
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
1183500000XPharmacist77321CA

General Provider Information

NPI Number : 1770092397
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN WASCHAK
Provider Business Mailing Address
First Line : 9310 TEXHOMA AVE
Second Line :
City : NORTHRIDGE
State : CA
Zip : 91325-2331
Country : US
Telephone Number : 818-314-4905
Fax Number :
Provider Business Practice Location Address
First Line : 14440 BURBANK BLVD
Second Line :
City : SHERMAN OAKS
State : CA
Zip : 91401-4823
Country : US
Telephone Number : 818-989-5422
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2017
Last Update Date : 09/26/2017

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Directions to “ JUSTIN WASCHAK ” Practice Location

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