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General NPI Number Information
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NPI Number | 1982927323
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Entity Type | Organization
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Legal Business Name | KOHANA PHARMACY AND CENTER FOR REGENERATIVE MEDICINE INC
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Dates
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Enumeration Date | 03/11/2010
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 181 TANK FARM RD STE 120
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7082
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Country | US
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Telephone | 805-542-0864
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Fax | 805-542-0867
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Provider Business Mailing Address
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Address Line | 181 TANK FARM RD SUITE 120
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-7080
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Country | US
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Telephone | 805-542-0864
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Fax | 805-542-0867
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Authorized Official
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Title or Position | PHARMACIST
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Name | ROBERT QUINN
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Credential | PHARMD
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Telephone | 805-542-0864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 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 #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 50264
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License Number State | CA
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