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NPI Code Detail

MEDICARE: MR. BRIAN MOCKLER PHARMD

MEDICARE: MR. BRIAN MOCKLER PHARMD
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
1183500000XPharmacist68566CA

General Provider Information

NPI Number : 1982012910
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRIAN MOCKLER PHARMD
Provider Business Mailing Address
First Line : 900 E WASHINGTON BLVD
Second Line :
City : CRESCENT CITY
State : CA
Zip : 95531-8118
Country : US
Telephone Number : 707-464-1452
Fax Number : 707-464-1627
Provider Business Practice Location Address
First Line : 900 E WASHINGTON BLVD
Second Line :
City : CRESCENT CITY
State : CA
Zip : 95531-8118
Country : US
Telephone Number : 707-464-1452
Fax Number : 707-464-1627
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2014
Last Update Date : 07/22/2014

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