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NPI Code Detail

MEDICARE: RAUL'S VINELAND PHARMACY

MEDICARE: RAUL'S VINELAND 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
1183500000XPharmacistPHY37601CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10579461OTHERCANABP

General Provider Information

NPI Number : 1902893852
Entity Type Code : Organization
Provider Name (Legal Business Name) : RAUL'S VINELAND PHARMACY
Provider Business Mailing Address
First Line : 11717 SATICOY ST
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91605-2833
Country : US
Telephone Number : 818-982-7825
Fax Number : 818-982-7827
Provider Business Practice Location Address
First Line : 11717 SATICOY ST
Second Line :
City : NORTH HOLLYWOOD
State : CA
Zip : 91605-2833
Country : US
Telephone Number : 818-982-7825
Fax Number : 818-982-7827
Authorized Official
Title or Position : OWNER
Name : MR. RAUL ANTONIO MERCURIO
Credential : ETC
Telephone Number : 818-982-7825
Provider Enumeration Date : 10/04/2005
Last Update Date : 06/16/2008

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Directions to “RAUL'S VINELAND PHARMACY ” Practice Location

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