MEDICARE: DEL SUR PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336L0003X	Long Term Care Pharmacy	55594	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2176915	OTHER		PK

General Provider Information

NPI Number	:	1215434873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEL SUR PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 9227
Second Line	:
City	:	RANCHO SANTA FE
State	:	CA
Zip	:	92067-4227
Country	:	US
Telephone Number	:	858-759-6625
Fax Number	:

Provider Business Practice Location Address
First Line	:	16089 SAN DIEGUITO RD # H102
Second Line	:
City	:	RANCHO SANTA FE
State	:	CA
Zip	:	92067-9529
Country	:	US
Telephone Number	:	858-759-6625
Fax Number	:	858-759-6729

Authorized Official
Title or Position	:	CEO
Name	:	BERNARD GRAMLICH
Credential	:
Telephone Number	:	858-759-6625

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	04/10/2018

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Directions to “DEL SUR PHARMACY ” Practice Location

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