| NPI | 1073818258 |
|---|---|
| Doing Business As | RANCHO SAN MIGUEL PHARMACY #21 |
| Entity Type | Organization |
| Authorized Contact | WADE L. FULLMER Pharmacist/PIC 209-939-0376 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: CA 50420) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 30915) |
| Enumeration Date | 2011-01-19 |
| Last Update Date | 2011-05-13 |