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General NPI Number Information
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NPI Number | 1184796690
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Entity Type | Organization
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Legal Business Name | GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATION
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 162 AS ABMAN DR
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City | INARAJAN
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State | GU
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Zip | 96917
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Country | US
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Telephone | 671-828-7547
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Fax | 671-828-7504
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Provider Business Mailing Address
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Address Line | 123 CHALAN KARETA
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City | MANGILAO
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State | GU
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Zip | 96913-6304
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Country | US
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Telephone |
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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 | MICHELLE DELOSO
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Credential | RPH
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Telephone | 671-635-7447
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number | PCY011
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License Number State | GU
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