| NPI | 1902918824 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVE RODERICK Owner 209-462-2145 |
| Organization Subpart ? | No |
| Primary Taxonomy | 333600000X Pharmacy (Licence: CA PHY46647) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-08-22 |