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General NPI Number Information
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NPI Number | 1295095909
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Entity Type | Organization
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Legal Business Name | DELAGO PHARAMACY INC
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Dates
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Enumeration Date | 05/29/2012
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 31739 RIVERSIDE DR SUITE J
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-7818
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Country | US
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Telephone | 909-730-2758
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Fax |
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Provider Business Mailing Address
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Address Line | 31739 RIVERSIDE DR SUITE J
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-7818
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Country | US
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Telephone | 909-730-2758
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Fax |
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Authorized Official
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Title or Position | PHARAMCIST IN CHARGE
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Name | MISS MARLENA A LUNING
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Credential | R. PH
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Telephone | 909-730-2758
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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 | 60361
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License Number State | CA
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