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General NPI Number Information
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NPI Number | 1942200902
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Entity Type | Organization
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Legal Business Name | CHULAVISTA PHARMACY LLC
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 384 H ST
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City | CHULA VISTA
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State | CA
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Zip | 91910-5513
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Country | US
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Telephone | 619-781-8177
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Fax | 619-623-3435
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Provider Business Mailing Address
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Address Line | 384 H ST
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City | CHULA VISTA
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State | CA
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Zip | 91910-5513
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Country | US
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Telephone | 619-781-8177
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Fax | 619-623-3435
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Authorized Official
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Title or Position | PHARMACIST/PARTNER
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Name | MR. ELVIS ATENCIO
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Credential | PHARMD
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Telephone | 619-781-8177
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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 | PHY55409
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License Number State | CA
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