MEDICARE: GERALD C DAVALOS

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	333600000X	Pharmacy	PHY22384	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861475519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERALD C DAVALOS

Provider Business Mailing Address
First Line	:	2505 NORIEGA STREET
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-4126
Country	:	US
Telephone Number	:	415-731-3535
Fax Number	:	415-731-8650

Provider Business Practice Location Address
First Line	:	2505 NORIEGA STREET
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94122-4126
Country	:	US
Telephone Number	:	415-731-3535
Fax Number	:	415-731-8650

Authorized Official
Title or Position	:	OWNER PHARMACIST
Name	:	GERALD CHARLES DAVALOS
Credential	:	PHARMD
Telephone Number	:	415-731-3535

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	05/17/2013

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