Healthcare Provider Details

I. General information

NPI: 1427318344
Provider Name (Legal Business Name): ALAMO PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 03/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 ALAMO ST STE 100
SIMI VALLEY CA
93063-2188
US

IV. Provider business mailing address

3695 ALAMO ST STE 100
SIMI VALLEY CA
93063-2188
US

V. Phone/Fax

Practice location:
  • Phone: 805-306-1636
  • Fax: 805-306-1689
Mailing address:
  • Phone: 805-306-1636
  • Fax: 805-306-1689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY51053
License Number StateCA

VIII. Authorized Official

Name: WASSIM ARMANIOUS
Title or Position: OWNER / PIC
Credential:
Phone: 818-723-3250