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NPI Code Detail

MEDICARE: SAN MIGUEL PHARMACY,INC

MEDICARE: SAN MIGUEL PHARMACY,INC
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
13336C0003XCommunity/Retail Pharmacy46505CA

General Provider Information

NPI Number : 1225121577
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAN MIGUEL PHARMACY,INC
Provider Business Mailing Address
First Line : 4476 TWEEDY BLVD
Second Line :
City : SOUTH GATE
State : CA
Zip : 90280-6359
Country : US
Telephone Number : 323-563-3233
Fax Number : 323-563-3934
Provider Business Practice Location Address
First Line : 4476 TWEEDY BLVD
Second Line :
City : SOUTH GATE
State : CA
Zip : 90280-6359
Country : US
Telephone Number : 323-563-3233
Fax Number : 323-563-3934
Authorized Official
Title or Position : CEO,PHARMACIST IN CHARGE
Name : MRS. GRACHUY ARUTYUNYAN
Credential : RPH
Telephone Number : 323-563-3233
Provider Enumeration Date : 10/01/2006
Last Update Date : 08/22/2020

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Directions to “SAN MIGUEL PHARMACY,INC ” Practice Location

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