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General NPI Number Information
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NPI Number | 1043505357
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Entity Type | Organization
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Legal Business Name | SIDAKA'S PHARMACY INC
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Dates
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Enumeration Date | 06/14/2011
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 31150 TEMECULA PKWY STE 100
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City | TEMECULA
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State | CA
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Zip | 92592-2921
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Country | US
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Telephone | 951-302-3111
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Fax | 951-302-3115
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Provider Business Mailing Address
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Address Line | 31150 TEMECULA PKWY STE 100
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City | TEMECULA
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State | CA
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Zip | 92592-2921
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Country | US
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Telephone | 951-302-3111
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Fax | 951-302-3115
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Authorized Official
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Title or Position | OWNER / PIC
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Name | SIDAKA CHOAU
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Credential |
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Telephone | 951-302-3111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY55945
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License Number State | CA
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