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General NPI Number Information
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NPI Number | 1043603780
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Entity Type | Organization
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Legal Business Name | VILLAGE ROSE PHARMACY, INC.
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 03/05/2015
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Provider Practice Location Address
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Address Line | 7773 UNIVERSITY AVE
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City | LA MESA
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State | CA
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Zip | 91942-4950
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Country | US
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Telephone | 619-741-1344
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Fax | 619-741-1322
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Provider Business Mailing Address
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Address Line | 7773 UNIVERSITY AVE
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City | LA MESA
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State | CA
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Zip | 91942-4950
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Country | US
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Telephone | 619-741-1344
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Fax | 619-741-1322
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Authorized Official
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Title or Position | OWNER
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Name | LORELEI NGUYEN
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Credential |
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Telephone | 619-750-8101
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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 | 51983
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License Number State | CA
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