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General NPI Number Information
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NPI Number | 1942952122
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Entity Type | Organization
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Legal Business Name | CEUTICARE LLC
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 1875 CALIFORNIA AVE STE 101
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City | CORONA
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State | CA
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Zip | 92881-6477
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Country | US
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Telephone | 951-817-1005
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Fax |
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Provider Business Mailing Address
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Address Line | 1875 CALIFORNIA AVE STE 101
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City | CORONA
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State | CA
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Zip | 92881-6477
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Country | US
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Telephone | 951-817-1005
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Fax |
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Authorized Official
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Title or Position | OWNER/PHARMACY MANAGER
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Name | SHIRLEY PHAM
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Credential |
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Telephone | 951-817-1005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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