Healthcare Provider Details

I. General information

NPI: 1609903715
Provider Name (Legal Business Name): HHSA PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROSECRANS ST
SAN DIEGO CA
92110-3115
US

IV. Provider business mailing address

16914 TORBETT LN #13
SAN DIEGO CA
92127-6803
US

V. Phone/Fax

Practice location:
  • Phone: 858-692-8033
  • Fax:
Mailing address:
  • Phone: 858-312-6642
  • Fax: 619-692-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. MARJORIE T MCDONOUGH
Title or Position: PHARMACY TECHNICIAN
Credential:
Phone: 619-692-8033