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NPI Code Detail

MEDICARE: MRS. CRISTIE PELLEGRINI BS PHARMACY

MEDICARE: MRS. CRISTIE PELLEGRINI BS PHARMACY
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
11835P1200XPharmacotherapy PharmacistRPH50943CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RPH50943OTHERCASTATE LICENSE #

General Provider Information

NPI Number : 1912906629
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CRISTIE PELLEGRINI BS PHARMACY
Provider Business Mailing Address
First Line : 144 STONY POINT RD
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-4122
Country : US
Telephone Number : 707-521-4590
Fax Number : 707-521-4599
Provider Business Practice Location Address
First Line : 144 STONY POINT RD
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-4122
Country : US
Telephone Number : 707-521-4590
Fax Number : 707-521-4599
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2005
Last Update Date : 07/08/2007

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