Individual
ANDREW MAGNAYE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
19201 BEAR VALLEY RD, APPLE VALLEY, CA 92308-2702
(760) 961-6943
Mailing address
4377 CLAIR ST, MONTCLAIR, CA 91763-6308
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
75265
CALIFORNIA STATE BOARD OF PHARMACY
CA
Enumeration date
08/19/2018
Last updated
08/19/2018
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