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General NPI Number Information
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NPI Number | 1639687585
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Entity Type | Organization
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Legal Business Name | CEUTICARE LLC
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Dates
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Enumeration Date | 01/12/2018
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Last Update Date | 10/29/2021
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Provider Practice Location Address
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Address Line | 1875 CALIFORNIA AVE STE 101
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City | CORONA
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State | CA
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Zip | 92881-6477
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Country | US
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Telephone | 951-817-1005
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Fax | 951-817-1020
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Provider Business Mailing Address
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Address Line | 1875 CALIFORNIA AVE STE 101
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City | CORONA
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State | CA
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Zip | 92881-6477
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Country | US
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Telephone | 951-817-1005
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Fax | 951-817-1020
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Authorized Official
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Title or Position | OWNER/PHARMACY MANAGER
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Name | SHIRLEY PHAM
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Credential | RPH
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Telephone | 951-817-1005
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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 | 55935
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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