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General NPI Number Information
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NPI Number | 1467564385
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Entity Type | Organization
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Legal Business Name | PAYLESS MARKETS INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/18/2013
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Provider Practice Location Address
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Address Line | 214 W MARINE CORPS DR RTE 1
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City | DEDEDO
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State | GU
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Zip | 96929-5913
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Country | US
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Telephone | 671-637-9783
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Fax | 671-637-9747
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Provider Business Mailing Address
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Address Line | 214 W MARINE CORPS DR RTE 1
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City | DEDEDO
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State | GU
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Zip | 96929-5913
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Country | US
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Telephone | 671-637-9783
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Fax | 671-637-9747
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Authorized Official
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Title or Position | GEN MGR
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Name | MICHAEL BENITO
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Credential | RPH
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Telephone | 671-477-9266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PCY026
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License Number State | GU
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