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Organization

SUBURBAN DRUG CO A CORP

Active
Other names
LOS COYOTES DRUG
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JERROLD LEE ROSENBAUM PHARM. D. (PRESIDENT)
(562) 420-1480
Entity
Organization

Contact information

Practice address
10572 CALLE LEE STE 138, LOS ALAMITOS, CA 90720-8541
(562) 420-1480
(866) 859-1508
Mailing address
10572 CALLE LEE STE 138, LOS ALAMITOS, CA 90720-8541
(562) 420-1480
(866) 859-1508

Taxonomy

Speciality
Code
Description
License number
State
3336L0003X
Long Term Care Pharmacy
Primary
PHY55814
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0510190
NCPDP#
CA
05
PHY55814
CA
Enumeration date
11/14/2006
Last updated
02/19/2018
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