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Organization
WAL-MART
Active
Organization
WAL-MART
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HALA GOURGY RPH (PHARMACY MANAGER)
(949) 837-0504
Entity
Organization
Contact information
Practice address
26502 TOWNE CENTRE DR, FOOTHILL RANCH, CA 92610-3448
(949) 837-0504
Mailing address
22612 MOJAVE LN, MISSION VIEJO, CA 92691-1519
(818) 256-9887
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY408530
CA
Other
Enumeration date
08/28/2014
Last updated
08/28/2014
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