Healthcare Provider Details

I. General information

NPI: 1063583078
Provider Name (Legal Business Name): HEALTHPLUS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 E FOOTHILL BLVD STE A
SAN LUIS OBISPO CA
93405-2701
US

IV. Provider business mailing address

948 E FOOTHILL BLVD STE A
SAN LUIS OBISPO CA
93405-2701
US

V. Phone/Fax

Practice location:
  • Phone: 805-543-5950
  • Fax: 805-543-3160
Mailing address:
  • Phone: 805-543-5950
  • Fax: 805-543-3160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY43683
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DANA NELSON
Title or Position: CEO PIC
Credential:
Phone: 805-543-5966