MEDICARE: DR. LAVIERO MICHAEL MANCINELLI PHARM. D.

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	45309	CA

General Provider Information

NPI Number	:	1912119405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAVIERO MICHAEL MANCINELLI PHARM. D.

Provider Business Mailing Address
First Line	:	242 ARDENDALE DRIVE
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94014
Country	:	US
Telephone Number	:	415-586-0810
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 EL CAMINO REAL
Second Line	:
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080
Country	:	US
Telephone Number	:	650-742-2486
Fax Number	:

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

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	07/08/2007

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