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NPI Code Detail

MEDICARE: MISSION PHARMACY & COMPOUNDING, LTD

MEDICARE: MISSION PHARMACY & COMPOUNDING, LTD
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
13336C0004XCompounding PharmacyPHY46560CA
23336C0003XCommunity/Retail PharmacyPHY46560CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PHY46560OTHERCARX LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
30555980OTHERCANCPDP

General Provider Information

NPI Number : 1841395761
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISSION PHARMACY & COMPOUNDING, LTD
Provider Business Mailing Address
First Line : 6020 SANTO RD
Second Line : SUITE B
City : SAN DIEGO
State : CA
Zip : 92124-1195
Country : US
Telephone Number : 858-467-0929
Fax Number : 858-467-0922
Provider Business Practice Location Address
First Line : 6020 SANTO RD
Second Line : SUITE B
City : SAN DIEGO
State : CA
Zip : 92124-1195
Country : US
Telephone Number : 858-467-0929
Fax Number : 858-467-0922
Authorized Official
Title or Position : PARTNER
Name : MRS. CELESTE FAVILA
Credential :
Telephone Number : 858-467-0929
Provider Enumeration Date : 09/14/2006
Last Update Date : 03/30/2010

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Directions to “MISSION PHARMACY & COMPOUNDING, LTD ” Practice Location

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