| NPI | 1225103807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BILL WALTER Phcy Dir 916-784-1590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: CA PHY38103) |
| Additional Taxonomies | 3336C0003X Pharmacy Community/Retail Pharmacy |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2020-08-22 |