| NPI | 1609927847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONOVAN WALLACE President/Owner 818-500-0079 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: CA 46287) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: CA 46287) |
| 3336C0004X Pharmacy Compounding Pharmacy (Licence: CA 46287) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2020-02-04 |