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General NPI Number Information
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NPI Number | 1134201916
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Entity Type | Organization
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Legal Business Name | JOHN MUIR AT ROSSMOOR PHCY
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 1220 ROSSMOOR PKWY
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City | WALNUT CREEK
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State | CA
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Zip | 94595-2501
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Country | US
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Telephone | 925-988-7510
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Fax | 925-988-7512
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Provider Business Mailing Address
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Address Line | 1220 ROSSMOOR PKWY
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City | WALNUT CREEK
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State | CA
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Zip | 94595-2501
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Country | US
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Telephone | 925-988-7510
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Fax | 925-988-7512
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Authorized Official
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Title or Position | PHCY COORDINATOR
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Name | LARRY DON
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Credential |
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Telephone | 925-988-7510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY47219
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License Number State | CA
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