Healthcare Provider Details

I. General information

NPI: 1134043854
Provider Name (Legal Business Name): DEVID PETRUS PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 PARKWAY DR
LA MESA CA
91942-2104
US

IV. Provider business mailing address

8010 PARKWAY DR
LA MESA CA
91942-2104
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: