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General NPI Number Information
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NPI Number | 1942826235
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Entity Type | Organization
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Legal Business Name | GOLDLEAF MED PHARMACY LTC LLC
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 1082 MELLON AVE
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City | MANTECA
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State | CA
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Zip | 95337-6119
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Country | US
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Telephone | 209-473-1600
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Fax | 209-800-1569
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Provider Business Mailing Address
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Address Line | 1082 MELLON AVE
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City | MANTECA
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State | CA
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Zip | 95337-6119
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Country | US
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Telephone | 209-473-1600
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Fax | 209-800-1569
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Authorized Official
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Title or Position | OPERATIONS
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Name | MARY T MORSE
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Credential |
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Telephone | 209-914-2269
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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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