MEDICARE: JOEN REDD N LEGISLADOR

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	PH0311	GU

General Provider Information

NPI Number	:	1770125148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEN REDD N LEGISLADOR

Provider Business Mailing Address
First Line	:	353 CHALAN SAN ANTONIO
Second Line	:	PHOTO TOWN PLAZA SUITE 100
City	:	TAMUNING
State	:	GU
Zip	:	96913-3392
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	353 CHALAN SAN ANTONIO STE 100
Second Line	:
City	:	TAMUNING
State	:	GU
Zip	:	96913-3300
Country	:	US
Telephone Number	:	671-649-1977
Fax Number	:	671-646-5338

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

Provider Enumeration Date	:	10/17/2019
Last Update Date	:	03/05/2025

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