Organization
SAN DIEGO COMMUNITY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OLLEN WILLIAMS JR. (PARTNER)
(619) 249-8623
Entity
Organization
Contact information
Practice address
3703 CAMINO DEL RIO S STE 215B, SAN DIEGO, CA 92108-4032
(619) 249-8623
Mailing address
3703 CAMINO DEL RIO S STE 215B, SAN DIEGO, CA 92108-4032
(619) 249-8623
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102302979
CA BOARD OF EQUALIZATION - SELLERS PERMIT
CA
01
—
20129010027
CA SECRETARY OF STATE
CA
Enumeration date
10/29/2012
Last updated
10/29/2012
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