Healthcare Provider Details

I. General information

NPI: 1538251459
Provider Name (Legal Business Name): SAN DG SANTEE PHCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 TOWN CENTER PKWY BLDG B
SANTEE CA
92701
US

IV. Provider business mailing address

110 TOWN CENTER PKWY BLDG B
SANTEE CA
92701
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-8528
  • Fax:
Mailing address:
  • Phone: 318-443-8528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: MANAGER PHARMACY OPERATIONS CENTER
Credential:
Phone: 210-221-8443