# SUBURBAN DRUG CO A CORP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LOS COYOTES DRUG
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144392226
- **Authorized official:** DR. JERROLD LEE ROSENBAUM PHARM. D. (PRESIDENT)
- **Authorized official phone:** (562) 420-1480

## Contact information

- **Practice address:** 10572 CALLE LEE STE 138, LOS ALAMITOS, CA 90720-8541
- **Practice address phone:** (562) 420-1480
- **Practice address fax:** (866) 859-1508
- **Mailing address:** 10572 CALLE LEE STE 138, LOS ALAMITOS, CA 90720-8541
- **Mailing address phone:** (562) 420-1480
- **Mailing address fax:** (866) 859-1508

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | PHY55814 | CA | Yes |

## Other

- **Enumeration date:** 11/14/2006
- **Last updated:** 02/19/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0510190 | NCPDP\# | CA |
| 05 | — | PHY55814 | — | CA |