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General NPI Number Information
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NPI Number | 1528254885
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Entity Type | Organization
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Legal Business Name | GOLDEN STATE PHARMACEUTICALS, LLC
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/27/2010
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Provider Practice Location Address
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Address Line | 768 CALLE PLANO
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City | CAMARILLO
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State | CA
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Zip | 93012
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Country | US
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Telephone | 818-857-9217
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Fax |
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Provider Business Mailing Address
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Address Line | 768 CALLE PLANO
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City | CAMARILLO
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State | CA
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Zip | 93012
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Country | US
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Telephone | 818-857-9217
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Fax |
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | KENNETH JACK AMODEO
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Credential |
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Telephone | 818-857-9217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number | 48647
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 48647
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License Number State | CA
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