Healthcare Provider Details

I. General information

NPI: 1255533006
Provider Name (Legal Business Name): GUAM MEDICAL PHARMACY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 N. MARINE CORPS DR. STE. #105
TAMUNING GU
96913-4426
US

IV. Provider business mailing address

744 N. MARINE CORPS DR. STE. #105
TAMUNING GU
96913-4426
US

V. Phone/Fax

Practice location:
  • Phone: 671-647-5572
  • Fax: 671-647-5573
Mailing address:
  • Phone: 671-647-5572
  • Fax: 671-647-5573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPCY043
License Number StateGU

VIII. Authorized Official

Name: MRS. CHALORNA FREITAS LAURON
Title or Position: MANAGER OWNER
Credential:
Phone: 671-647-5572