Healthcare Provider Details

I. General information

NPI: 1720449267
Provider Name (Legal Business Name): HOT SPRINGS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13313 PALM DR STE A
DESERT HOT SPRINGS CA
92240-5980
US

IV. Provider business mailing address

13313 PALM DR STE A
DESERT HOT SPRINGS CA
92240-5980
US

V. Phone/Fax

Practice location:
  • Phone: 760-251-2222
  • Fax: 760-251-1200
Mailing address:
  • Phone: 760-251-2222
  • Fax: 760-251-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY54379
License Number StateCA

VIII. Authorized Official

Name: MARKO FAM
Title or Position: CEO / PIC / OWNER / AO
Credential: RPH
Phone: 760-251-2222