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General NPI Number Information
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NPI Number | 1225121577
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Entity Type | Organization
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Legal Business Name | SAN MIGUEL PHARMACY,INC
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Dates
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Enumeration Date | 10/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4476 TWEEDY BLVD
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City | SOUTH GATE
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State | CA
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Zip | 90280-6359
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Country | US
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Telephone | 323-563-3233
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Fax | 323-563-3934
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Provider Business Mailing Address
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Address Line | 4476 TWEEDY BLVD
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City | SOUTH GATE
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State | CA
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Zip | 90280-6359
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Country | US
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Telephone | 323-563-3233
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Fax | 323-563-3934
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Authorized Official
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Title or Position | CEO,PHARMACIST IN CHARGE
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Name | MRS. GRACHUY ARUTYUNYAN
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Credential | RPH
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Telephone | 323-563-3233
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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 | 46505
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License Number State | CA
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