MEDICARE: JIAZHI ZHENG

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	74117	CA

General Provider Information

NPI Number	:	1811353105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIAZHI ZHENG

Provider Business Mailing Address
First Line	:	688 ECHO LAKE WAY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-5780
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	688 ECHO LAKE WAY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-5780
Country	:	US
Telephone Number	:	608-698-1221
Fax Number	:

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

Provider Enumeration Date	:	01/04/2016
Last Update Date	:	01/04/2016

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Directions to “ JIAZHI ZHENG ” Practice Location

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