| NPI | 1558580241 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT BOYD LAKE CEO 714-904-3951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336M0002X Pharmacy, Mail Order Pharmacy (Licence: AZ 4076) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: AZ 4076) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2022-05-17 |