Healthcare Provider Details

I. General information

NPI: 1023152071
Provider Name (Legal Business Name): CRUZ PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 FARENHOLT AVE
TAMUNING GU
96913-3208
US

IV. Provider business mailing address

224 FARENHOLT AVE
TAMUNING GU
96913-3208
US

V. Phone/Fax

Practice location:
  • Phone: 671-646-5556
  • Fax: 671-649-0469
Mailing address:
  • Phone: 671-646-5556
  • Fax: 671-649-0469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPCY013
License Number StateGU

VIII. Authorized Official

Name: MS. KAREN HEE SONG
Title or Position: PHARMACY MANAGER
Credential: RPH
Phone: 671-646-5556