Healthcare Provider Details

I. General information

NPI: 1548140007
Provider Name (Legal Business Name): GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W SANTA MONICA AVE
DEDEDO GU
96929-5286
US

IV. Provider business mailing address

123 CHALAN KARETA
MANGILAO GU
96913-6304
US

V. Phone/Fax

Practice location:
  • Phone: 671-788-4098
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JESSICA YANIT
Title or Position: PHARMACY MANAGER
Credential:
Phone: 671-735-7139