| NPI | 1669617734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLLEN WILLIAMS Technician 858-622-1278 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0004X Pharmacy Compounding Pharmacy (Licence: CA PHY49147) |
| Additional Taxonomies | 333600000X Pharmacy |
| 3336C0003X Pharmacy Community/Retail Pharmacy | |
| 3336M0002X Pharmacy Mail Order Pharmacy | |
| 3336S0011X Pharmacy Specialty Pharmacy | |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2015-10-23 |