Organization
LODI MEMORIAL HOSPITAL ASSOCIATION INC
Active
Other names
LODI HEALTH PHARMACY WEST
Organization subpart
No
Provider details
NPI number
Authorized official
GARY AIROLA BS (PIC/MANAGER)
(209) 333-3009
Entity
Organization
Contact information
Practice address
2415 W VINE ST, 104B, LODI, CA 95242-3731
(209) 333-3009
(209) 333-3110
Mailing address
2415 W VINE ST, 104B, LODI, CA 95242
(209) 333-3009
(209) 333-3110
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY53672
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2003584
PK
—
05
—
PHB367420
—
CA
Enumeration date
07/04/2006
Last updated
07/19/2018
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