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NPI Code Detail

MEDICARE: IMGRX SLO, INC.

MEDICARE: IMGRX SLO, 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
1333600000XPharmacy
23336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1558976761
Entity Type Code : Organization
Provider Name (Legal Business Name) : IMGRX SLO, INC.
Provider Business Mailing Address
First Line : 13651 DUBLIN CT
Second Line :
City : STAFFORD
State : TX
Zip : 77477-4317
Country : US
Telephone Number : 281-749-2547
Fax Number : 614-652-0326
Provider Business Practice Location Address
First Line : 1330 LAS TABLAS RD STE 140
Second Line :
City : TEMPLETON
State : CA
Zip : 93465-9758
Country : US
Telephone Number : 805-542-6708
Fax Number : 805-542-6793
Authorized Official
Title or Position : VICE PRESIDENT, MANAGED SERVICES
Name : MICHAEL BROWN
Credential :
Telephone Number : 281-749-4764
Provider Enumeration Date : 09/14/2020
Last Update Date : 01/11/2023

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Directions to “IMGRX SLO, INC. ” Practice Location

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