# GOVERNMENT OF GUAM DEPARTMENT OF ADMINISTRATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Region Community Health Center Pharmacy (SRCHC)
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184796690
- **Authorized official:** MICHELLE DELOSO RPH (PHARMACY MANAGER)
- **Authorized official phone:** (671) 635-7447

## Contact information

- **Practice address:** 162 AS ABMAN DR, INARAJAN, GU 96917
- **Practice address phone:** (671) 828-7547
- **Practice address fax:** (671) 828-7504
- **Mailing address:** 123 CHALAN KARETA, MANGILAO, GU 96913-6304

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0002X | Clinic Pharmacy | PCY011 | GU | Yes |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 11/14/2006
- **Last updated:** 09/28/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2112062 | PK | — |
| 05 | — | 636 | — | GU |