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Organization
COUNTY OF SAN DIEGO
Active
Organization
COUNTY OF SAN DIEGO
Active
Other names
EDGEMOOR HOSPITAL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
GWENMARIE HILLEARY (ADMINISTRATOR)
(619) 596-5500
Entity
Organization
Contact information
Practice address
655 PARK CENTER DR, SANTEE, CA 92071-6957
(619) 596-6340
(619) 596-6341
Mailing address
655 PARK CENTER DR, SANTEE, CA 92071-6957
(619) 596-6340
(619) 596-6341
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
—
NULL
3336L0003X
Long Term Care Pharmacy
Primary
34002
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2114082
PK
—
05
—
ZZT05008F
—
CA
Enumeration date
07/30/2006
Last updated
11/12/2015
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