MEDICARE: JOHN WILLIAM HIGHTOWER III 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	36112	CA
2	183500000X	Pharmacist	13992	FL

General Provider Information

NPI Number	:	1891072088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WILLIAM HIGHTOWER III RPH

Provider Business Mailing Address
First Line	:	2360 BAY ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94123-1809
Country	:	US
Telephone Number	:	415-608-0673
Fax Number	:	415-474-0631

Provider Business Practice Location Address
First Line	:	2120 POLK ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-2507
Country	:	US
Telephone Number	:	415-474-9752
Fax Number	:	415-474-0631

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

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	11/15/2011

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