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General NPI Number Information
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NPI Number | 1598985673
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Entity Type | Organization
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Legal Business Name | MONTEAGLE MEDICAL CENTER PHARMACY
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Dates
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Enumeration Date | 04/30/2007
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 1580 VALENCIA ST.
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City | SAN FRANCISCO
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State | CA
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Zip | 94110
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Country | US
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Telephone | 415-641-6550
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Fax | 415-641-6713
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Provider Business Mailing Address
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Address Line | 1580 VALENCIA ST.
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City | SAN FRANCISCO
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State | CA
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Zip | 94110
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Country | US
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Telephone | 415-641-6550
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Fax | 415-641-6713
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Authorized Official
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Title or Position | SR. VP OF OPERATION
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Name | MR. GRANT DAVIES
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Credential |
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Telephone | 415-600-3790
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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 | 186360
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License Number State | CA
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