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General NPI Number Information
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NPI Number | 1356430045
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Entity Type | Organization
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Legal Business Name | A FAMILY PHARMACY-HESPERIA
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 04/15/2008
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Provider Practice Location Address
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Address Line | 11919 HESPERIA RD STE C
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City | HESPERIA
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State | CA
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Zip | 92345-1855
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Country | US
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Telephone | 760-244-3777
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Fax | 760-242-8617
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Provider Business Mailing Address
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Address Line | PO BOX 900
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City | VICTORVILLE
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State | CA
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Zip | 92393-0900
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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 | PRESIDENT
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Name | THOMAS TEKELE
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Credential | PHARMACIST
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Telephone | 760-242-5452
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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 | PHY46638
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License Number State | CA
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