MEDICARE: JENANA HALILOVIC PHARM.D., BCPS

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	60577	CA
2	1835P1200X	Pharmacotherapy Pharmacist	60577	CA

General Provider Information

NPI Number	:	1942536479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENANA HALILOVIC PHARM.D., BCPS

Provider Business Mailing Address
First Line	:	2505 I ST
Second Line	:	#B
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-4259
Country	:	US
Telephone Number	:	401-829-2825
Fax Number	:

Provider Business Practice Location Address
First Line	:	2505 I ST
Second Line	:	#B
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-4259
Country	:	US
Telephone Number	:	401-829-2825
Fax Number	:

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

Provider Enumeration Date	:	10/18/2009
Last Update Date	:	10/18/2009

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