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General NPI Number Information
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NPI Number | 1164558797
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Entity Type | Organization
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Legal Business Name | JOSE R SARDINAS
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 11930 HAWTHORNE BLVD
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City | HAWTHORNE
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State | CA
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Zip | 90250-3016
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Country | US
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Telephone | 310-973-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 11930 HAWTHORNE BLV
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City | HAWTHORNE
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State | CA
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Zip | 90250
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Country | US
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Telephone | 310-973-5200
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Fax | 310-973-1243
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | DR. JOSE R SARDINAS
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Credential | PHARMACIST
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Telephone | 310-973-5200
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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 | PHY20259
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License Number State | CA
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