MEDICARE: SIRI CHE PHARMACIST

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	S14885	AZ

General Provider Information

NPI Number	:	1942530050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIRI CHE PHARMACIST

Provider Business Mailing Address
First Line	:	10705 W INDIAN SCHOOL RD
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85392-5636
Country	:	US
Telephone Number	:	623-877-3245
Fax Number	:	623-877-1706

Provider Business Practice Location Address
First Line	:	10705 W INDIAN SCHOOL RD
Second Line	:
City	:	AVONDALE
State	:	AZ
Zip	:	85392-5636
Country	:	US
Telephone Number	:	623-877-3245
Fax Number	:	623-877-1706

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

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	01/12/2010

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