Healthcare Provider Details

I. General information

NPI: 1245251297
Provider Name (Legal Business Name): COUNTY OF SAN DIEGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 04/13/2016
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

3851 ROSECRANS ST
SAN DIEGO CA
92110-3115
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-5741
  • Fax: 619-692-8034
Mailing address:
  • Phone: 619-692-5741
  • Fax: 619-692-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberHPE35645
License Number StateCA

VIII. Authorized Official

Name: WILLIAM MASTIN
Title or Position: CHIEF PHARMACIST
Credential:
Phone: 619-692-5600