Healthcare Provider Details

I. General information

NPI: 1780433060
Provider Name (Legal Business Name): REMEDY HOLISTIC PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 05/17/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W CEDAR ST STE 103
SAN DIEGO CA
92101-3064
US

IV. Provider business mailing address

6965 EL CAMINO REAL # 105-575
CARLSBAD CA
92009-4100
US

V. Phone/Fax

Practice location:
  • Phone: 619-915-5862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HAIDI VATTOLO
Title or Position: CEO
Credential:
Phone: 951-392-6494