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General NPI Number Information
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NPI Number | 1225610710
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Entity Type | Organization
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Legal Business Name | ROQUEBULILAN INC
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Dates
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Enumeration Date | 04/23/2021
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 1905 HILLHURST AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027
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Country | US
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Telephone | 323-573-3439
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 HILLHURST AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027
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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 | SECRETARY
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Name | ROSELYN ROQUE
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Credential | PHARMACIST
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Telephone | 323-522-3893
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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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