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Organization
REDWOOD COMPOUNDING PHARMACY INC
Active
Organization
REDWOOD COMPOUNDING PHARMACY INC
Active
Other names
REDWOOD COMPOUNDING PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOUSSIE HAILEMARIAM PHARM D (PRESIDENT/ PIC)
(707) 541-6186
Entity
Organization
Contact information
Practice address
600 MARTIN AVE, STE 125, ROHNERT PARK, CA 94928-7919
(707) 541-6186
(707) 541-6287
Mailing address
600 MARTIN AVE, STE 125, ROHNERT PARK, CA 94928-7919
(707) 541-6186
(707) 541-6287
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PHY50691
CA
3336C0003X
Community/Retail Pharmacy
PHY50691
CA
3336C0004X
Compounding Pharmacy
Primary
PHY50691
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PHY50691
CALIFORNIA STATE BOARD OF PHARMACY RETAIL PERMIT
CA
Enumeration date
11/22/2011
Last updated
11/22/2011
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