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General NPI Number Information
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NPI Number | 1407153273
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Entity Type | Organization
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Legal Business Name | PARK MEDICAL PHARMACY, INC
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Dates
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Enumeration Date | 02/14/2011
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Last Update Date | 02/14/2011
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Provider Practice Location Address
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Address Line | 450 4TH AVE SUITE 100
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City | CHULA VISTA
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State | CA
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Zip | 91910-4426
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Country | US
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Telephone | 619-420-0540
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Fax | 619-420-7750
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Provider Business Mailing Address
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Address Line | 450 4TH AVE SUITE 100
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City | CHULA VISTA
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State | CA
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Zip | 91910-4426
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Country | US
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Telephone | 619-420-0540
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Fax | 619-420-7750
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Authorized Official
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Title or Position | GENERAL OPERATIONS MANAGER
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Name | MS. SUSIE PIMENTEL
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Credential |
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Telephone | 619-238-9501
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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 | PHY50576
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License Number State | CA
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