| NPI | 1720136765 |
|---|---|
| Doing Business As | ENBORG LANE PHARMACY |
| Entity Type | Organization |
| Authorized Contact | ALFONSO F BANUELOS Chief Medical Officer 408-885-4001 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 333600000X Pharmacy (Licence: CA PHE 48983) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: CA HPE35791) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2010-03-19 |