MEDICARE: KIMLONG THI MEYER 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	60703	CA

General Provider Information

NPI Number	:	1902180250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMLONG THI MEYER PHARMD

Provider Business Mailing Address
First Line	:	6199 SUNRISE BLVD
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-6834
Country	:	US
Telephone Number	:	916-726-6802
Fax Number	:	916-726-6834

Provider Business Practice Location Address
First Line	:	6199 SUNRISE BLVD
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-6834
Country	:	US
Telephone Number	:	916-726-6802
Fax Number	:	916-726-6834

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

Provider Enumeration Date	:	10/05/2011
Last Update Date	:	10/05/2011

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