MEDICARE: MR. SAMIR BHARAT MEHTA PHARM. D

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	50744	CA

General Provider Information

NPI Number	:	1780126425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SAMIR BHARAT MEHTA PHARM. D

Provider Business Mailing Address
First Line	:	8469 ENTREKEN WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-4460
Country	:	US
Telephone Number	:	858-386-6798
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-2013
Country	:	US
Telephone Number	:	562-591-4417
Fax Number	:	562-591-0417

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

Provider Enumeration Date	:	11/11/2016
Last Update Date	:	11/11/2016

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