Healthcare Provider Details

I. General information

NPI: 1841395761
Provider Name (Legal Business Name): MISSION PHARMACY & COMPOUNDING, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 SANTO RD SUITE B
SAN DIEGO CA
92124-1195
US

IV. Provider business mailing address

6020 SANTO RD SUITE B
SAN DIEGO CA
92124-1195
US

V. Phone/Fax

Practice location:
  • Phone: 858-467-0929
  • Fax: 858-467-0922
Mailing address:
  • Phone: 858-467-0929
  • Fax: 858-467-0922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY46560
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHY46560
License Number StateCA

VIII. Authorized Official

Name: MRS. CELESTE FAVILA
Title or Position: PARTNER
Credential:
Phone: 858-467-0929