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General NPI Number Information
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NPI Number | 1558781591
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Entity Type | Organization
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Legal Business Name | THE LAHANA GROUP, LLC
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 710 FIERO LN SUITE 26
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7900
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Country | US
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Telephone | 805-250-1144
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Fax | 888-698-4759
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Provider Business Mailing Address
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Address Line | 710 FIERO LN SUITE 26
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7900
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Country | US
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Telephone | 805-250-1144
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Fax | 888-698-4759
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Authorized Official
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Title or Position | OWNER
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Name | SAMUEL PATRICK CLEMONS
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Credential |
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Telephone | 805-729-0147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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