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General NPI Number Information
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NPI Number | 1942674304
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Entity Type | Organization
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Legal Business Name | DATE PHARMACY INC
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 39765 DATE ST STE 101
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City | MURRIETA
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State | CA
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Zip | 92563-2005
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Country | US
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Telephone | 951-696-5400
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Fax | 951-696-5411
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Provider Business Mailing Address
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Address Line | 39765 DATE ST STE 101
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City | MURRIETA
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State | CA
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Zip | 92563-2005
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Country | US
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Telephone | 951-696-5400
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Fax | 951-696-5411
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Authorized Official
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Title or Position | OWNER, PRES, AO
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Name | AN NGUYEN
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Credential |
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Telephone | 559-765-1325
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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 | PHY53783
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License Number State | CA
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