Healthcare Provider Details

I. General information

NPI: 1760862924
Provider Name (Legal Business Name): SHARP GROSSMONT HOSPITAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR OUTPATIENT PHARMACY
LA MESA CA
91942-3019
US

IV. Provider business mailing address

11192 SOCORRO ST
SAN DIEGO CA
92129-1321
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-4458
  • Fax: 619-740-4354
Mailing address:
  • Phone: 858-449-9475
  • Fax: 619-740-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberRPH38344
License Number StateCA

VIII. Authorized Official

Name: MS. KARLENE KAY SARRISIN
Title or Position: STAFF PHARMACIST
Credential: R.PH.
Phone: 619-740-4451