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General NPI Number Information
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NPI Number | 1982701058
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Entity Type | Individual
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Provider Name | MARK LEROY DIMRY RPH DPH
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 286 N EUCLID AVE SEMCA PHARMACY
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City | SAN DIEGO
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State | CA
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Zip | 92114
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Country | US
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Telephone | 619-263-6635
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Fax | 619-263-4686
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Provider Business Mailing Address
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Address Line | 3266 FIRST AVE 10
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City | SAN DIEGO
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State | CA
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Zip | 92103
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Country | US
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Telephone | 619-574-1021
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 42116
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 13343
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License Number State | OK
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