MEDICARE: TEGAN BOOZ

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	83974	CA

General Provider Information

NPI Number	:	1932796844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEGAN BOOZ

Provider Business Mailing Address
First Line	:	1281 9TH AVE UNIT 608
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-4643
Country	:	US
Telephone Number	:	913-787-3459
Fax Number	:

Provider Business Practice Location Address
First Line	:	4404 EL CAJON BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4310
Country	:	US
Telephone Number	:	619-280-5006
Fax Number	:

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

Provider Enumeration Date	:	12/26/2020
Last Update Date	:	12/26/2020

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Directions to “ TEGAN BOOZ ” Practice Location

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