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General NPI Number Information
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NPI Number | 1609918820
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Entity Type | Organization
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Legal Business Name | PREUSS PHARMACY
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 844 SANTA CRUZ AVE
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City | MENLO PARK
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State | CA
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Zip | 94025-4610
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Country | US
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Telephone | 650-321-8045
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Fax | 650-321-7105
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Provider Business Mailing Address
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Address Line | 844 SANTA CRUZ AVE
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City | MENLO PARK
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State | CA
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Zip | 94025-4610
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Country | US
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Telephone | 650-321-8045
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Fax | 650-321-7105
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN CELEDON
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Credential | PHARM D.
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Telephone | 650-321-8045
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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 | PHY44383
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License Number State | CA
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