Healthcare Provider Details

I. General information

NPI: 1336348119
Provider Name (Legal Business Name): AMERICAN DRUG STORES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 ENCINITAS BLVD
ENCINITAS CA
92024-3728
US

IV. Provider business mailing address

455 ENCINITAS BLVD
ENCINITAS CA
92024-3728
US

V. Phone/Fax

Practice location:
  • Phone: 760-436-4055
  • Fax: 760-436-3832
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY36352
License Number StateCA

VIII. Authorized Official

Name: MR. LORENZO TORRES III
Title or Position: NEW STORE ENROLLMENTS
Credential:
Phone: 847-916-4463