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General NPI Number Information
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NPI Number | 1700958584
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Entity Type | Organization
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Legal Business Name | JDUB PHARMA
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2611 E THOMPSON BLVD SUITE 103
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City | VENTURA
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State | CA
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Zip | 93003
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Country | US
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Telephone | 805-648-2724
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Fax | 805-648-7562
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Provider Business Mailing Address
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Address Line | 2611 E THOMPSON BLVD SUITE 103
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City | VENTURA
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State | CA
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Zip | 93003-2743
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Country | US
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Telephone | 805-648-2724
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Fax | 805-648-7562
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Authorized Official
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Title or Position | MANAGER
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Name | CARLOS VARELA
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Credential |
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Telephone | 805-648-2724
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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 | PHY56114
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License Number State | CA
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