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General NPI Number Information
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NPI Number | 1588991954
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Entity Type | Organization
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Legal Business Name | TSP FIRST HEALTH LLC
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Dates
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Enumeration Date | 11/05/2009
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Last Update Date | 11/05/2009
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Provider Practice Location Address
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Address Line | 2030 DIAMOND BLVD
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City | CONCORD
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State | CA
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Zip | 94520-5702
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Country | US
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Telephone | 702-616-6940
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Fax |
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Provider Business Mailing Address
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Address Line | 2030 DIAMOND BLVD
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City | CONCORD
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State | CA
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Zip | 94520-5702
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Country | US
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Telephone | 702-616-6940
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MARCELINO CASAL
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Credential |
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Telephone | 818-468-6355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 50126
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License Number State | CA
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