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Organization
IHC SANTA YSABEL PHARMACY
Active
Organization
IHC SANTA YSABEL PHARMACY
Active
Other names
IHC Santa Ysabel Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT SCHOSTAG (PHARMACY DIRECTOR)
(760) 749-1410
Entity
Organization
Contact information
Practice address
110 1/2 SCHOOL HOUSE CANYON ROAD, SANTA YSABEL, CA 92070
(760) 233-5587
(760) 765-3769
Mailing address
PO BOX 10, SANTA YSABEL, CA 92070-0010
(760) 233-5587
(760) 765-3769
Taxonomy
Speciality
Code
Description
License number
State
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
Primary
PHY46552
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148638
PK
—
Enumeration date
11/17/2014
Last updated
11/17/2014
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