MEDICARE: DR. JESSICA LYNE CUDMORE 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	65035	CA

General Provider Information

NPI Number	:	1972898864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA LYNE CUDMORE PHARM.D

Provider Business Mailing Address
First Line	:	5800 BIRDCAGE ST
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-6800
Country	:	US
Telephone Number	:	916-500-1263
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 BIRDCAGE ST
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-6800
Country	:	US
Telephone Number	:	916-500-1263
Fax Number	:

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

Provider Enumeration Date	:	06/18/2011
Last Update Date	:	07/07/2014

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