Healthcare Provider Details

I. General information

NPI: 1891228367
Provider Name (Legal Business Name): ALVARADO PHARMACY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 RESERVOIR DR STE 114
SAN DIEGO CA
92120-5197
US

IV. Provider business mailing address

5555 RESERVOIR DR STE 114
SAN DIEGO CA
92120-5197
US

V. Phone/Fax

Practice location:
  • Phone: 619-287-5035
  • Fax: 619-287-5098
Mailing address:
  • Phone: 619-287-5035
  • Fax: 619-287-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number55582
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FRANK BROWER
Title or Position: DR.
Credential:
Phone: 619-287-5035