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General NPI Number Information
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NPI Number | 1750484820
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Entity Type | Organization
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Legal Business Name | LARK REXALL DRUGS INC
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 16251 MAIN ST
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City | GUERNEVILLE
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State | CA
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Zip | 95446-8300
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Country | US
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Telephone | 707-869-9055
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Fax | 707-869-9203
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Provider Business Mailing Address
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Address Line | 16251 MAIN ST
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City | GUERNEVILLE
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State | CA
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Zip | 95446-8300
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Country | US
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Telephone | 707-869-9055
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Fax | 707-869-9203
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MRS. AMALIA NICOLA
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Credential | PHARMACY TECH
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Telephone | 707-869-9055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHY 51871
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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 | PHY 51871
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License Number State | CA
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