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General NPI Number Information
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NPI Number | 1831613793
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Entity Type | Organization
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Legal Business Name | POWAY PHARMACY LLC
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Dates
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Enumeration Date | 08/01/2017
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 14837 POMERADO RD
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City | POWAY
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State | CA
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Zip | 92064-2803
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Country | US
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Telephone | 858-842-4206
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Fax | 951-674-9773
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Provider Business Mailing Address
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Address Line | 14837 POMERADO RD
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City | POWAY
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State | CA
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Zip | 92064-2803
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Country | US
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Telephone | 858-842-4206
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Fax | 858-842-4257
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. GHOLAM ROUZITALAB
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Credential | PHARM.D.
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Telephone | 858-842-4206
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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 |
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License Number State |
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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 | 55623
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License Number State | CA
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