Healthcare Provider Details

I. General information

NPI: 1245363670
Provider Name (Legal Business Name): SHARP GROSSMONT HOSPITAL PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

IV. Provider business mailing address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-4458
  • Fax: 619-740-4887
Mailing address:
  • Phone: 619-740-4458
  • Fax: 619-740-4887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberHSP 37455
License Number StateCA

VIII. Authorized Official

Name: DR. PATRICK CRAYCHEE
Title or Position: PHARMACY DIRECTOR
Credential: PHARM.D.
Phone: 619-740-4458