MEDICARE: DR. MICHAEL JOHN CASTAGNO 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	PHY45684	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	94-3413314	OTHER	CA	FEDERAL TAX ID

General Provider Information

NPI Number	:	1821095704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOHN CASTAGNO PHARM.D.

Provider Business Mailing Address
First Line	:	5260 HILDRETH LN
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95212-2320
Country	:	US
Telephone Number	:	209-948-0950
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 WATERLOO RD
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95205-3738
Country	:	US
Telephone Number	:	209-466-2522
Fax Number	:	209-466-2589

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	09/10/2015

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