MEDICARE: SHADI VACCANI PHARMD

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	58804	CA

General Provider Information

NPI Number	:	1841468378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHADI VACCANI PHARMD

Provider Business Mailing Address
First Line	:	SAN DIEGO MISSION RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-2139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	SAN DIEGO MISSION RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-2139
Country	:	US
Telephone Number	:	800-290-5000
Fax Number	:

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

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	07/25/2013

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