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General NPI Number Information
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NPI Number | 1568746410
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Entity Type | Organization
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Legal Business Name | SENIOR CARE PHARMACY OF THE WEST, LLC
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 927 INDUSTRIAL WAY
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City | LODI
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State | CA
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Zip | 95240-3105
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Country | US
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Telephone | 888-915-3566
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Fax | 888-692-5991
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Provider Business Mailing Address
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Address Line | 927 INDUSTRIAL WAY
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City | LODI
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State | CA
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Zip | 95240-3105
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Country | US
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Telephone | 888-915-3566
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Fax | 888-692-5991
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GLEN KEITH ANDERSON
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Credential | RPH
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Telephone | 801-410-1980
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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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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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