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General NPI Number Information
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NPI Number | 1306366950
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Entity Type | Organization
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Legal Business Name | CGM PHARMACY CORPORATION
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Dates
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Enumeration Date | 06/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1340 BLUE OAKS BLVD STE 110
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City | ROSEVILLE
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State | CA
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Zip | 95678-7038
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Country | US
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Telephone | 916-771-4778
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Fax | 916-771-0492
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Provider Business Mailing Address
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Address Line | 1340 BLUE OAKS BLVD STE 110
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City | ROSEVILLE
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State | CA
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Zip | 95678-7038
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Country | US
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Telephone | 916-771-4778
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Fax | 916-771-0492
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Authorized Official
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Title or Position | SECRETARY
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Name | GLORY ANNE VELILLA
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Credential |
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Telephone | 916-771-4778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHY55112
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License Number State | CA
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