# WHITE CROSS DRUG STORE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609887199
- **Authorized official:** MAX ATIYA (OWNER)
- **Authorized official phone:** (619) 284-1141

## Contact information

- **Practice address:** 4074 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1608
- **Practice address phone:** (619) 284-1141
- **Practice address fax:** (619) 284-0503
- **Mailing address:** 4074 FAIRMOUNT AVE, SAN DIEGO, CA 92105-1608

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | PHY45196 | CA | Yes |

## Other

- **Enumeration date:** 08/10/2006
- **Last updated:** 08/31/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0595681 | OTHER ID NUMBER | — |
| 05 | — | PHA451960 | — | CA |