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General NPI Number Information
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NPI Number | 1124313853
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Entity Type | Organization
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Legal Business Name | TARGET
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 06/10/2011
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Provider Practice Location Address
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Address Line | 3600 ROSEMEAD BLVD
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City | ROSEMEAD
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State | CA
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Zip | 91700
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Country | US
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Telephone | 626-280-4908
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 ROSEMEAD BLVD T-1411
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City | ROSEMEAD
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State | CA
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Zip | 91770-2066
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Country | US
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Telephone | 626-280-4908
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MISS DORIS FONG
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Credential |
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Telephone | 626-280-4908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 54911
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License Number State | CA
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