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General NPI Number Information
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NPI Number | 1508884271
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Entity Type | Organization
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Legal Business Name | FRED SUFFICOOL & DAN GRIFFIN PTRS
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 10/06/2010
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Provider Practice Location Address
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Address Line | 7200 PARKWAY DRIVE SUITE 104
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City | LA MESA
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State | CA
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Zip | 91942-1534
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Country | US
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Telephone | 619-644-2170
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Fax | 619-644-2174
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Provider Business Mailing Address
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Address Line | 7200 PARKWAY DRIVE SUITE 104
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City | LA MESA
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State | CA
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Zip | 91942-1534
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Country | US
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Telephone | 619-644-2170
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Fax | 619-644-2174
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Authorized Official
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Title or Position | CONTROLLER / MANAGER
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Name | MR. STEPHEN J GRISWOLD
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Credential |
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Telephone | 619-644-2170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | PHY44577
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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