| NPI | 1386021475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND ROLAND LOPEZ Owner 714-963-9595 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 332900000X Non-Pharmacy Dispensing Site (Licence: CA G47742) |
| Enumeration Date | 2015-04-28 |
| Last Update Date | 2015-10-19 |