MEDICARE: MISS IDA RAGOJO SOMERA RPH

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	65492	CA

General Provider Information

NPI Number	:	1780930404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS IDA RAGOJO SOMERA RPH

Provider Business Mailing Address
First Line	:	7620 N EL DORADO ST
Second Line	:	APT 154
City	:	STOCKTON
State	:	CA
Zip	:	95207
Country	:	US
Telephone Number	:	209-478-1598
Fax Number	:

Provider Business Practice Location Address
First Line	:	4774 WEST LANE
Second Line	:	APT 154
City	:	STOCKTON
State	:	CA
Zip	:	95210
Country	:	US
Telephone Number	:	209-473-9170
Fax Number	:	209-473-9174

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

Provider Enumeration Date	:	07/31/2012
Last Update Date	:	07/31/2012

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