NPI | 1619203841 |
---|---|
Doing Business As | FRUITVALE AVENUE PHARMACY INC |
Entity Type | Organization |
Authorized Contact | KALPESH PATEL Pharmacist/Owner 510-406-3089 |
Organization Subpart ? | No |
Primary Taxonomy | 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: CA 50064) |
Additional Taxonomies | 3336L0003X Pharmacy Long Term Care Pharmacy |
Enumeration Date | 2009-10-22 |
Last Update Date | 2015-07-17 |