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NPI Code Detail

MEDICARE: EMILY DODGE

MEDICARE: EMILY DODGE
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
1183500000XPharmacist75729CA

General Provider Information

NPI Number : 1902357882
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY DODGE
Provider Business Mailing Address
First Line : 815 CANYON DEL REY BLVD
Second Line :
City : DEL REY OAKS
State : CA
Zip : 93940-5525
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 815 CANYON DEL REY BLVD
Second Line :
City : DEL REY OAKS
State : CA
Zip : 93940-5525
Country : US
Telephone Number : 831-313-2104
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2016
Last Update Date : 10/17/2016

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Directions to “ EMILY DODGE ” Practice Location

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