| NPI | 1629604368 |
|---|---|
| Doing Business As | CREEKSIDE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | TONY IBRAHIM CEO 760-987-6796 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336L0003X Pharmacy, Long Term Care Pharmacy |
| Enumeration Date | 2020-03-13 |
| Last Update Date | 2020-03-13 |