Healthcare Provider Details

I. General information

NPI: 1598790339
Provider Name (Legal Business Name): OBJ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6056 EL TORDO
RANCHO SANTA FE CA
92067-1188
US

IV. Provider business mailing address

PO BOX 1188
RANCHO SANTA FE CA
92067-1188
US

V. Phone/Fax

Practice location:
  • Phone: 858-400-1127
  • Fax: 858-756-4725
Mailing address:
  • Phone: 858-756-3096
  • Fax: 858-756-4725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY41024
License Number StateCA

VIII. Authorized Official

Name: MR. ROBERT E GRAUL
Title or Position: PRESIDENT
Credential: RPH
Phone: 858-756-3096